The effect of hypnosis on pain and peripheral blood flow in sickle-cell disease: a pilot study

Abstract

BackgroundVaso-occlusive pain crises (VOCs) are the “hallmark” of sickle-cell disease (SCD) and can lead to sympathetic nervous system dysfunction. Increased sympathetic nervous system activation during VOCs and/or pain can result in vasoconstriction, which may increase the risk for subsequent VOCs and pain. Hypnosis is a neuromodulatory intervention that may attenuate vascular and pain responsiveness. Due to the lack of laboratory-controlled pain studies in patients with SCD and healthy controls, the specific effects of hypnosis on acute pain-associated vascular responses are unknown. The current study assessed the effects of hypnosis on peripheral blood flow, pain threshold, tolerance, and intensity in adults with and without SCD.Subjects and methodsFourteen patients with SCD and 14 healthy controls were included. Participants underwent three laboratory pain tasks before and during a 30-minute hypnosis session. Peripheral blood flow, pain threshold, tolerance, and intensity before and during hypnosis were examined.ResultsA single 30-minute hypnosis session decreased pain intensity by a moderate amount in patients with SCD. Pain threshold and tolerance increased following hypnosis in the control group, but not in patients with SCD. Patients with SCD exhibited lower baseline peripheral blood flow and a greater increase in blood flow following hypnosis than controls.ConclusionGiven that peripheral vasoconstriction plays a role in the development of VOC, current findings provide support for further laboratory and clinical investigations of the effects of cognitive–behavioral neuromodulatory interventions on pain responses and peripheral vascular flow in patients with SCD. Current results suggest that hypnosis may increase peripheral vasodilation during both the anticipation and experience of pain in patients with SCD. These findings indicate a need for further examination of the effects of hypnosis on pain and vascular responses utilizing a randomized controlled trial design. Further evidence may help determine unique effects of hypnosis and potential benefits of integrating cognitive–behavioral neuromodulatory interventions into SCD treatment.

Hypnosis intervention for the management of pain perception during cataract surgery

“… 8 , 9 A limited number of studies have demonstrated the efficacy of clinical hypnosis in the treatment of pain and anxiety in severe diseases. 10 – 12 In the context of anesthesia, hypnosis can be used alone or in combination with the drugs typically used in anesthetic regimens, and increasing evidence supports the value of hypnosis in reducing patient stress and anxiety and inducing relaxation. 13 , 14 …”

Patients with sickle-cell disease exhibit greater functional connectivity and centrality in the locus coeruleus compared to anemic controls

“…However, no published reports currently exist with regards to patients with SCD (Seminowicz and Moayedi, 2017). Mindfulness meditation and hypnosis are other non-pharmacological treatments shown to be effective in improving blood flow, reducing activity in the dlPFC, and decreasing pain sensitivity (Barrett et al, 2016; Bhatt et al, 2017; Jensen et al, 2014; Jensen and Patterson, 2014; Zeidan et al, 2015, 2012). It would be useful to test strategies that alter this neural pathway in patients with SCD.…”

Targeting novel mechanisms of pain in sickle cell disease

“…Recently, attention has been focused on perception-based components of pain because of their ability to reduce pain via nonpharmacologic behavioral techniques, such as guided imagery, mindfulness and relaxation training, hypnosis, and cognitive behavioral therapy. [35][36][37] Chronic pain and central sensitization in SCD…”