Effects of Hypnotic Analgesia and Transcranial Direct Current Stimulation on Pain Tolerance and Corticospinal Excitability in Individuals with Fibromyalgia: A Cross-Over Randomized Clinical Trial.

Objective: We compare the effect of HAS, a-tDCS on the left dorsolateral prefrontal cortex (l-DLPFC), and rest-testing on pain measures [(cold pressor test (CPT) (primary outcome) and heat pain threshold]. We also compare their effects on the motor evoked potential (MEP) (primary outcome), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). Methods: This randomized, blind, crossover trial included 18 women with fibromyalgia, aged from 18 to 65 years old. They received at random and in a crossover order a-tDCS over the l-DLPFC (2mA), HAS, or a rest-testing. Results: HAS compared to a-tDCS increased the pain tolerance with a moderate effect size (ES) [Cohen's f=-0.78; (CI 95%; -1.48 to -0.12)]. While compared to rest-testing, HAS increased the CPT with a large ES [Cohen's f=-0.87; (CI 95%; -1.84 to -0.09)]. The a-tDCS compared to HAS increased the MEP amplitude with large ES [Cohen's f=-1.73 (CI 95%; -2.17 to -0.17)]. Likewise, its ES compared to rest-testing in the MEP size was large [Cohen's f=-1.03; (CI 95%; -2.06 to -0.08)]. Conclusion: These findings revealed that HAS affects contra-regulating mechanisms involved in perception and pain tolerance, while the a-tDCS increased the excitability of the corticospinal pathways. They give a subsidy to investigate their effect as approaches to counter regulate the maladaptive neuroplasticity involved in fibromyalgia. Clinical Trial Registration: www.ClinicalTrials.gov, identifier - NCT05066568.

Hypnotherapy, Intermittent Fasting, and Exercise Group Programs in Atopic Dermatitis: A Randomized Controlled Explorative Clinical Trial During the COVID-19 Pandemic.

Background: Patients with atopic dermatitis (AD) frequently use healthy lifestyle behaviors, although their benefits are unclear. This study's aim was to investigate the effectiveness of hypnotherapy, fasting with diet adjustments, and exercise in AD patients. Methods: In a four-armed randomized controlled monocenter open explorative clinical trial, adult patients with mild-to-moderate severe AD underwent, over 16 weeks, a five-session hypnotherapy group program (HTP), a five-session intermittent fasting with diet adjustment group program (IFDP), a five-session exercise group program (EP), or no study intervention (control) as add-on to topical corticosteroid use if required. Endpoints included subjectively perceived itching on a visual analogue scale (VAS, 0-100 mm); disease severity by SCORing Atopic Dermatitis (SCORAD); and adverse events (AEs). Endpoints were analyzed descriptively in the Full Analysis Set (FAS). Due to the coronavirus disease 2019 (COVID-19) pandemic, relevant changes to the study protocol included online in addition to "in-presence" group interventions, closing the study arm EP and premature trial termination before randomization of 120 intended patients. Results: During the COVID-19 pandemic, study recruitment was poor. The FAS included 20 patients (17 female) with 35.0 ± 12.1 (mean ± standard deviation [SD]) years of age. At baseline, mean ± SD for HTP (n = 6), IFDP (n = 4), EP (n = 1), and control (n = 9) were VAS itching 63.2 ± 18.0, 65.0 ± 13.9, 43.0 mm, 62.1 ± 17.3; SCORAD 43.0 ± 13.6, 47.0 ± 21.0, 60.3, 39.1 ± 15.6. After 16 weeks, endpoints were VAS itching 26.0 ± 16.4, 31.7 ± 9.9, 23.0 mm, 39.3 ± 27.0; SCORAD 24.1 ± 12.2, 29.1 ± 19.1, 49.1, 25.5 ± 14.4. No serious AEs related to the interventions were observed. Conclusion: Despite very small groups, study results indicated potential beneficial changes to baseline in perceived itching intensity, disease severity, and disease-specific quality of life for HTP and IFDP. Therefore, further clinical trials should be performed investigating the effectiveness and safety of all interventions. Trial registration: January 31, 2020 German Clinical Trials Register (DRKS): DRKS00020557, Universal Trial Number (UTN): U1111-1247-1512.

Effect Of Different MAC Values On Bispectral Index In Isoflurane Anaesthesia

Introduction: The bispectral index monitors the unawareness component of balanced anaesthesia and gives us the depth of Anesthesia.It reflects the response of the brain to a variety of hypnotic and inhaled anaesthesia agents. The aim of this study was to see the effect of different MAC values of isoflurane on the bispectral index and hemodynamic variations at different MAC values. Material(s) and Method(s): This prospective study was conducted on 20 patients at tertiary care center for 6 months. After induction of Anesthesia, following parameters were recorded: noninvasive blood pressure measurement, heart rate, oxygen saturation, ETCo2 and BIS values. The BIS was continuously monitored and when the MAC values of isoflurane were 0.5, 0.7, 1, 1.2 and 1.5 corresponding BIS values and all the other haemodynamic parameters were noted. Result(s): In 11 patients out of 20 patients satisfactory BIS of 40-60 was achieved at MAC 0.5. In 16 out of 20 patients satisfactory BIS 40-60 was achieved at 0.7 MAC. In all the 20 patients satisfactory BIS was achieved at 1 MAC.In 2 out of 20 patients we couldn't proceed beyond 1.0 MAC because of the fall in MAP to <65mm of Hg. In 4 out of 20 patients we couldn't proceed beyond 1.2MAC because of the fall in MAP to <65mm of Hg. Conclusion(s): Isoflurane produced satisfactory BIS of 40-60 in 16 patients at 0.7 MAC and in all the 20 patients at 1 MAC.Use of BIS in our study helped in better titration of Isoflurane according to patient's individual needs thereby we avoided light plane of anaesthesia or deep hypnosis and the adverse effects associated with it. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Veterans Health Administration's National Delivery of CIH Therapies, Whole Health Services and Chiropractic Care in 2020 and the Pivot to Telehealth

Methods: Databases were searched using CPT codes (acupuncture, chiropractic, and massage therapy), clinic stop codes (chiropractic care), clinic location names, internal accounting codes, clinic note titles, and structured coding templates (Health Factors) unique to VHA's electronic medical record. Results: A total of 441,891 Veterans used 2,930,700 of these services in FY20, representing a slight decrease from FY19 (3,083,806 total visits). Prior to the COVID19 pandemic, VHA was on track for expanded utilization in FY20. Of these visits, 422,313 (14%) were delivered through telehealth. Over 8.1% of all Veterans receiving VHA care in FY20 received at least oneCIH therapy, Whole Health service, or chiropractic care service. Use was highest among women (14.3%), patients with chronic pain (18.1%), opioid use disorder (15.6%), rheumatoid arthritis (13.3%), obesity (12.9%), or a mental health condition (12.8%). VHA medical centers worked quickly during the pandemic to expand telehealth offerings;comparing against FY19, nearly onethird of the monthly in-person visit volume was provided through telehealth by the end of 2020 for therapies including Core Whole Health services, yoga, Tai Chi/Qigong, meditation, biofeedback, guided imagery, and hypnosis. Background: Given that VHA is the largest healthcare system provider of CIH therapies in the U.S., we examined the VHA's national provision of nine CIH therapies (acupuncture, battlefield acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga), chiropractic care, and Whole Health services for fiscal years (FYs) 2017 to 2020 using data from electronic medical records and community-based claims, and assessed utilization as VHA expanded CIH offerings and pivoted to tele-CIH and tele-Whole Health in response to the COVID19 pandemic. Conclusion: Despite the impact of COVID19 on reduced FY20 in-person visits, including group CIH therapies, VHA continued to provide nearly the same number of visits as the prior year, in part due to expansion of telehealth services.

Complementary and Integrative Health in the Community: Expanding Access for Veterans Seeking Care through the Veterans Health Administration

Methods: Data were pulled from an internal administrative dashboard. Referrals include services for Veterans who live a prescribed driving distance from a VAMC, wait times over threshold, services unavailable, or for reasons of the best medical interest. Data was pulled for fiscal years 2020 through 2021 and included: chiropractic care, acupuncture, biofeedback, neuron feedback, clinical hypnosis, massage therapy, meditation (specifically MBSR), Tai Chi/qigong, and yoga. Standardized tracking of referrals began with the implementation of Standard Episodes of Care (SEOC) which define care requested and include number of visits permitted and timeframe. Results: Referrals increased for all approaches from FY20-21 shown as (FY20;FY21): chiropractic (104,197;197,357), acupuncture (59,787;100,908), massage therapy (5,021;17,646), biofeedback (31;69), neuron feedback (27;74), clinical hypnosis (10;40), MBSR (2;8), Tai Chi (2;8) and Yoga (1;2). Background: The Veterans Health Administration (VHA) Directive 1137: Provision of Complementary and Integrative Health (CIH) identifies the inclusion of evidence-based CIH approaches in the VHA's Medical Benefits Package (acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/qigong, and yoga). The purpose of this administrative data review is to identify which approaches are being referred to Community Care from VHA medical centers (VAMC), and to identify if COVID-19 has had an impact on referrals to the community. Conclusion: CIH is expanding across the VHA and could be useful in supporting a cultural transformation that includes integrative health approaches within conventional medical systems. While all VAMCs provide some CIH in-house, a substantial amount is provided through Community Care. As the largest integrated healthcare system in the United States, this could impact growth of CIH and the need for more providers in the community. By hiring CIH professionals onstation and expanding the network to the community, VHA could be one of the largest providers and users of CIH.

Mezile’s Model (Back Massage and Self-Hypnosis) Based on Information and Technology to Lose the Anxiety of Postpartum Mothers in COVID-19 Pandemic Era

BACKGROUND: The roles of husbands to keep the psychological condition of pregnant and postpartum mothers are low. Many husbands could not perform full attention and support during the pregnancy, delivery, and postpartum period. Heretofore, the researchers do not find studies that include the roles of the husband from antenatal until postnatal care during the COVID-19 pandemic. AIM: This research aims to create Mezile’s model in the form of back massage and self-hypnosis based on information and technology with adequate design and effective implementation to lose the anxiety of postpartum mothers. This model also involved husbands taking the role from the antenatal until postnatal care. METHODS: This research and development used a true experimental design with pre-and post-test control group design. The researchers used simple random sampling. The subjects consisted of 50 participants in the experimental group and 50 participants in the control group. The experimental group received the intervention with self-hypnosis training, while the husbands of the experimental group received back massage training. The husbands in the control group received only back massage training. The intervention lasted from the 2nd until the 15th day after normal delivery. Then, mothers with post-section cesarean received the training on the 8th until the 21st day. The researchers used Wilcoxon and Mann–Whitney tests. RESULTS: Mezile’s model refers to back massage and self-hypnosis based on information and technology. It was reliable as the holistic-based education media to apply effective management to lose anxiety (p = 0.03), higher than the control group. CONCLUSION: Mezile’s model, back massage, and self-hypnosis, based on information and technology, are reliable for obstetric care education based on holistic nature during pregnancy and postpartum. The implementation was effective in managing the anxiety of postpartum mothers in the control group.

Using hypnosis for stress and burnout

On top of an already stress-laden life, the COVID-19 pandemic has introduced a substantial amount of stress, concern, and exposure to trauma risk factors. Healthcare professionals are particularly prone to high stress environments and, thus, are at an even greater risk for burnout. While lay recommendations for self-care are limited, hypnosisbased interventions open an alternative path to managing stress and minimizing the risk and impact of burnout. The speakers of the SCEH 2021 Presidential Symposium will discuss different approaches to using hypnosis for stress management, burnout reduction, and addressing related and relevant symptoms.

Central Taurine Attenuates Hyperthermia and Isolation Stress Behaviors Augmented by Corticotropin-Releasing Factor with Modifying Brain Amino Acid Metabolism in Neonatal Chicks.

The objective of this study was to determine the effects of centrally administered taurine on rectal temperature, behavioral responses and brain amino acid metabolism under isolation stress and the presence of co-injected corticotropin-releasing factor (CRF). Neonatal chicks were centrally injected with saline, 2.1 pmol of CRF, 2.5 µmol of taurine or both taurine and CRF. The results showed that CRF-induced hyperthermia was attenuated by co-injection with taurine. Taurine, alone or with CRF, significantly decreased the number of distress vocalizations and the time spent in active wakefulness, as well as increased the time spent in the sleeping posture, compared with the saline- and CRF-injected chicks. An amino acid chromatographic analysis revealed that diencephalic leucine, isoleucine, tyrosine, glutamate, asparagine, alanine, ß-alanine, cystathionine and 3-methylhistidine were decreased in response to taurine alone or in combination with CRF. Central taurine, alone and when co-administered with CRF, decreased isoleucine, phenylalanine, tyrosine and cysteine, but increased glycine concentrations in the brainstem, compared with saline and CRF groups. The results collectively indicate that central taurine attenuated CRF-induced hyperthermia and stress behaviors in neonatal chicks, and the mechanism likely involves the repartitioning of amino acids to different metabolic pathways. In particular, brain leucine, isoleucine, cysteine, glutamate and glycine may be mobilized to cope with acute stressors.

["Bull'therapy", a decompression chamber for carers]. / La "Bull'thérapie", un sas de décompression pour les soignants.

As part of a global approach to supporting carers in times of health crisis, the Elbeuf-Louviers-Val de Reuil hospital (76) has launched an experiment in "Bull'therapy". By providing a connected hypnosis mask, caregivers can benefit from a time of break time away from the stressful situations they face during their work.

Integrative behavioral treatment for NREM parasomnias: a case series.

NONE: A variety of behavioral interventions have been shown to improve symptoms of non-rapid eye movement parasomnias. Prior reports have typically examined outcomes of a single behavioral intervention. However, non-rapid eye movement parasomnias may benefit from a multipronged treatment approach similar to that used in the behavioral treatment of other sleep disorders. Through a series of 3 case reports, we demonstrate the utility of a case-conceptualization based, integrative approach to behavioral treatment of adult non-rapid eye movement parasomnias. For all patients (2 with disorders of arousal and 1 with sleep-related eating disorder), symptoms were satisfactorily reduced after 3-6 sessions. Treatment was tailored to each individual, but common elements included education, hypnosis, and identifying and reducing priming factors (eg, stress, insufficient sleep) and precipitating factors (eg, noise or touch from bed partners).