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Nhyp55(2).book(nhyp_a_217717.fm)Intl. Journal of Clinical and Experimental Hypnosis, 55(2): 207–219, 2007Copyright International Journal of Clinical and Experimental HypnosisISSN: 0020-7144 print / 1744-5183 onlineDOI: 10.1080/00207140601177921 al Hy nosis, Vol. 55, No. 2, January 2007: pp. 1–24 REVIEW OF THE EFFICACY OF CLINICAL
HYPNOSIS WITH HEADACHES AND
D. CORYDON HAMMOND1 University of Utah School of Medicine, Salt Lake City, Utah, USA Abstract: The 12-member National Institute of Health Technology
Assessment Panel on Integration of Behavioral and Relaxation
Approaches into the Treatment of Chronic Pain and Insomnia (1996)
reviewed outcome studies on hypnosis with cancer pain and con-
cluded that research evidence was strong and that other evidence
suggested hypnosis may be effective with some chronic pain, includ-
ing tension headaches. This paper provides an updated review of the
literature on the effectiveness of hypnosis in the treatment of head-
aches and migraines, concluding that it meets the clinical psychology
research criteria for being a well-established and efficacious treat-
ment and is virtually free of the side effects, risks of adverse reactions,
and ongoing expense associated with medication treatments.
Hypnosis has an impressive history in the treatment of pain begin- ning with reports in the mid-1800s (Elliotson, 1843; Esdaile, 1846/1976)of major surgeries that were performed with hypnosis as sole anesthe-sia. More recently, a meta-analytic review of contemporary research(Montgomery, DuHamel, & Redd, 2000) documented that hypnosismeets the American Psychological Association Clinical PsychologyDivision's criteria (Chambless et al., 1998; Chambless & Hollon, 1998) asan efficacious and specific treatment for pain, showing superiority to pilland psychological placebos, as well as other treatments. The 12-memberNational Institute of Health Technology Assessment Panel on Integra-tion of Behavioral and Relaxation Approaches into the Treatment ofChronic Pain and Insomnia (1996) representing family medicine, socialmedicine, psychology, psychiatry, public health, nursing, and epide-miology, along with 23 expert consultants who presented data to thepanel, examined behavioral and relaxation approaches to insomniaand pain. After an extensive literature search, they reached the conclu-sion that a number of well-defined behavioral and relaxation Manuscript submitted January 20, 2006; final revision accepted June 10, 2006.
1Address correspondence to D. Corydon Hammond, Ph.D., University of Utah School of Medicine, PM&R, 30 No. 1900 East, Salt Lake City, UT 84132-2119, USA.
E-mail: D.C.Hammond@utah.edu D. CORYDON HAMMOND techniques now exist and are effective in treating chronic pain andinsomnia.
The evidence supporting the effectiveness of hypnosis in alleviatingchronic pain associated with cancer seems strong. In addition, the panelwas presented with other data suggesting the effectiveness of hypnosisin other chronic pain conditions, which include irritable bowel syn-drome, oral mucositis, temporomandibular disorders, and tensionheadaches. (p. 315) The remainder of this article will review the literature on the effec- tiveness of hypnosis with tension and migraine headaches. Researchon autogenic training will also be included as it represents a structuredGerman form of self-hypnosis training.
LITERATURE REVIEW In a controlled study, Anderson, Basker, and Dalton (1975) com- pared outcomes in 47 patients (age 14 or older) who were randomlyassigned to receive either medication treatment (n = 24) with prochlor-perazine (Stemetil) and ergotamine (which was to be taken at the firstwarning of a migraine) or to hypnotherapy (n = 23). All patients hadsuffered with migraines for a minimum of 1 year. Hypnotic treatmentconsisted of six sessions at intervals of 10 to 14 days. Only experiencedhypnotherapists provided treatment, which consisted of induction,deepening, suggestive therapy, and ego-strengthening followingHartland's (1971) model. Hypnotic suggestions included having lesstension, anxiety, and apprehension. They were also told to visualizethe arteries in the neck and head as being swollen and throbbing andto then imagine them becoming smaller and more comfortable.
Patients were instructed in self-hypnosis to avert migraine attacks andasked to practice self-hypnosis daily. Outcome measures included thenumber of migraines, how many were Grade 4 (defined as "blindingand totally incapacitating"), and the number of patients who were freefrom migraines at monthly intervals. Follow-up was done for 1 year.
The pretreatment frequency of migraines was not significantly differ-ent between the two experimental groups. The results found that thenumber of migraines per month was significantly (p < .0005) less in thehypnosis group and the number of "blinding attacks" was also signifi-cantly (p < .005) lower in the hypnosis group. Medication treatmentwas found to significantly lower the frequency of migraines or ofGrade 4 migraines. In the second 6 months of treatment, the hypnosisgroup averaged only .5 migraines per month compared with 2.9 permonth in the medication group. At 1-year follow-up, the number ofhypnosis patients who had experienced complete remission ofmigraines during the previous 3 months was 43.5% (10 patients) CLINICAL HYPNOSIS AND HEADACHE REVIEW compared with 12.5% (3) of the patients in the medication treatmentcondition; a difference that was also significant (p < .039).
Another excellent prospective, randomized, double-blind, placebo- controlled study with classic juvenile migraine was conducted by Olness,MacDonald, and Uden (1987). Children (aged 6–12) were included in a4-week baseline period, a 1-week period (Period 1) to begin placebo orpropranolol medication treatment, a 1-week washout period, followed bya similar 12-week treatment period (Period 2). At the end of Period 2, allchildren were instructed in self-hypnosis and were followed for another12 weeks (Period 3). During Periods 1 and 2, the children were ran-domly assigned to either Group 1 (placebo–placebo–self-hypnosis),Group 2 (propranolol–placebo–self-hypnosis), or Group 3 (placebo–propranolol–self-hypnosis). Compliance was excellent and was assessedevery 4 weeks by counting pills, and headache diaries were kept. Fivesessions were conducted where self-hypnosis training occurred. In thefirst visit, a progressive relaxation induction was used along with pleas-ant imagery of the child's choosing. They were asked to practice self-hypnosis twice daily for 10 minutes. One week later the exercise was doneagain but included several techniques being offered for self-regulation ofpain from which the patient could choose things to incorporate into theirself-hypnosis practice. In the third visit, 2 weeks later, the practice alsoinvolved glove anesthesia. Two further visits were held at 1-month inter-vals. At the end of 1 year, the mean number of migraines per child in theplacebo group was 13.3 (SD = 9.5), 14.9 (SD = 12.9) in the medicationtreatment group, and 5.8 (SD = 5.8) in the hypnosis group, whichwas statistically significant (p < .045).
Emmerson and Trexler (1999) utilized group hypnosis with relaxation and vascular manipulation (imagery of a cool helmet with freezer coilsbehind the protective cover) to evaluate the effectiveness of hypnosis inreducing migraine duration, frequency, severity, and need for medication.
Pretreatment trend and posttreatment effect were evaluated using a sin-gle-group, time-series design. During the 12-week pretreatment baselineperiod, the 32 patients recorded details about their migraines and medica-tion use. Twelve weeks of treatment began with a group hypnosis session,and patients were provided with prerecorded self-hypnosis tapes. Post-treatment duration of migraine was found to be significantly shorter(p < .0005), frequency of migraines was significantly lower (p < .0001),migraine severity was significantly reduced (p < .0005), and medicationusage was reduced by almost 50% (p < .0005). The posttreatment durationof migraine per participant was 155.54 hours, in comparison with 260.28hours for the same period of time prior to treatment (a 40.25% reduction).
The group mean frequency of migraines during the 12-week pretreatmentphase was 22.88, while in the posttreatment phase it was 16.8. The severityon a 1 to 3 scale went from an average 1.99 to 1.35 at the same time medi-cation was reduced by about half.
D. CORYDON HAMMOND Andreychuk and Skriver (1975) randomly assigned 33 migraine sub- jects to one of three experimental treatment groups: self-hypnosis train-ing, biofeedback training for hand-warming combined with listening toautogenic training tapes, or biofeedback training with a bipolar EEGmontage connection in the left and right occipital area that was designedto enhance alpha brain waves. Each treatment group received one45-minute session a week for 10 weeks. Subjects in each group wereencouraged to practice twice a day between sessions. All three treatmentgroups experienced a significant reduction in migraines from pretreat-ment levels, reaching significance at the .025 level for alpha training andself-hypnosis training groups and .01 level for the hand-temperaturetraining group. The Hypnotic Induction Profile (Spiegel & Spiegel, 1978)was administered to all subjects, and, cutting across all treatmentgroups, high hypnotizable subjects demonstrated significant (p < .05)reduction in migraine rates compared with low hypnotizable subjects.
The common denominator in all three treatment groups was that theyall emphasized learning and practicing relaxation.
Spanos and colleagues (1993) randomly assigned a sample of 136 chronic-headache patients to either one or four sessions of imagery-basedhypnotic treatment, one or four sessions of a placebo treatment ("sublimi-nal reconditioning"), or to a no-treatment control group. Daily headacheactivity was monitored for a 3-week baseline and for an 8-week follow-up.
Of the total sample, 15% were classified as having migraines, 54% as suf-fering with tension headaches, and 32% as having mixed tension/migraine headaches. Control patients reported no significant changes inheadache activity, whereas hypnotic and placebo subjects reported signif-icant (p < .05) but equivalent changes. Medication usage in treated subjectsdecreased significantly (p < .001). Similar to Andreychuk and Skriver(1975), this study demonstrated that hypnotic treatments incorporatingrelaxation and imagery are more effective than no treatment in reducingchronic headache activity and in decreasing medication usage (andimprovements could not be accounted for in terms of any increased use ofanalgesic medication). The outcome shows, however, that nonspecific fac-tors may be operative. Nonetheless, the results do not support a sociocog-nitive theoretical perspective (e.g., Kirsch, 1985), because expectations oftreatment success obtained after one session and after four sessions oftreatment were not found to be predictors of outcome, even though thehypnotic treatment produced significantly stronger expectations of treat-ment success than the placebo treatment. A possible limitation of thestudy was that it was based on a student volunteer sample rather than aclinical sample, particularly since patient motivation has been found to bea significant predictor of successful headache treatment (Gallagher &Warner, 1984).
The effectiveness of four sessions of hypnosis and self-hypnosis training in comparison with a wait-list control group in the treatment CLINICAL HYPNOSIS AND HEADACHE REVIEW of chronic tension headaches was evaluated by Melis, Rooimans,Spierings, and Hoogduin (1991) in a single-blind study. The 1-hourhypnosis sessions utilized eye fixation and relaxation inductions, fol-lowed by imagery modification in which the patient visualized animage of the headache gradually changing. Suggestions were alsogiven to transform the pain into sensations that were easier to tolerateand for transferring the pain from the head to a less disabling part ofthe body. Each patient received a self-hypnosis tape that was madeduring each of the four sessions. Patients coming to a headache clinicafter previously unsuccessful treatment were randomly assigned to ahypnosis (n = 11) or a wait-list control condition (n = 15). Patients wereunaware of the existence of the wait-list control condition. A 4-weekbaseline, data-gathering period preceded randomized assignment, andthe therapist never inspected data that was gathered. Outcome mea-sures included number of headache days, number of headache hoursper day, and intensity of headaches. At 4-week follow-up, the hypno-sis group was found to be experiencing significant reductions (p < .05)in number of headache days, hours, and intensity of headaches com-pared to the wait-list control group. They also showed a significant(p < .01) reduction in anxiety as measured by Zung's Self-Rating Anxi-ety Scale (Zung, 1971). Improvement was confirmed by subjectiveevaluation and questionnaire data showing a significant reduction inanxiety scores (p < .01). Hypnosis patients reported that the trainingmade it easier for them to relax, gave them a sense of control over theheadaches, changed their perception of the pain, and prevented ten-sion from building up during the day.
Mannix, Chandurkar, Rybicki, Tusek, and Solomon (1999) evalu- ated the effect of guided imagery on 129 patients with chronic tensionheadaches. The subjects completed the Headache Disability Inventoryand the Medical Outcomes Study Short Form (SF-36) at their initialvisit to a specialty headache center and again a month after the visit. Inaddition to individualized headache therapy (administered by a physi-cian and that could include abortive and prophylactic pharmacologicaltreatments, physical therapy, biofeedback, and dietary instruction),patients were instructed to listen daily to a 20-minute commerciallyavailable guided-imagery audiotape during the month. A controlgroup of 131 patients received the individualized headache-clinic ther-apy but without guided imagery. Both the traditional medical treat-ment controls and the patients who listened to the guided-imagerytape improved in headache frequency, headache severity, globalassessment, quality of life, and disability caused by headache. Theoverall improvements in the two groups in comparison to baselinewere highly significant (p = .004). However, significantly (p < .05) moreguided-imagery patients (21.7%) than controls (7.6%) indicated thattheir headaches were much better. The guided-imagery patients had D. CORYDON HAMMOND significantly more improvement than the controls in three of the eightSF-36 domains: bodily pain (p < .049), vitality (p < .009), and mentalhealth (p < .034). No adverse effects were reported in patients usingguided imagery. It was concluded that guided imagery is an effectiveadjunct therapy for the management of chronic tension-type headache.
A group from the Netherlands published a series of studies on ten- sion headaches. Van Dyck, Zitman, Linssen, Corry, and Spinhoven(1991) investigated the relative efficacy of autogenic training versusself-hypnosis training utilizing future-oriented hypnotic imagery in thetreatment of tension headaches. It also sought to evaluate the extent towhich therapy factors such as relaxation, imagery skills, and hypnotiz-ability mediated therapy outcome. Fifty-five patients were randomlyassigned to the two therapy conditions (28 to autogenic training and 27to hypnosis). Each group completed four therapy sessions and twoassessment sessions and were to practice at home. The two procedureswere found to be equally effective in reducing headache pain, usage ofpain medication, depression, and state anxiety. In the self-hypnosiscondition, pain reduction was associated with depth of relaxation thatwas achieved during home practice (as assessed with diaries) andimagery capacity (assessed with the Dutch version of the CreativeImagination Scale). Interestingly, pain reduction from autogenic train-ing appeared to be mediated differently from self-hypnosis and wasunrelated to imagery skills, degree of relaxation, or hypnotizability.
After statistically controlling for relaxation and imagery, hypnotizabil-ity scores on the Stanford Hypnotic Clinical Scale (Morgan & Hilgard,1975) were significantly correlated with ratings of pain reduction.
Zitman, Van Dyck, Spinhoven, Linssen, and Corrie (1992) compared an abbreviated form of autogenic training (six exercises learned infixed order) to a hypnosis group that used a technique of future-oriented hypnotic imagery (imagining the self in the future, pain-free),and to still a third condition that used the future-oriented hypnoticimagery but without presenting it as being hypnosis. Patients weredescribed as having headache complaints for at least 6 months (76%had been suffering for over 2 years). All three interventions empha-sized muscular and mental relaxation, and tapes were used for homepractice. Treatment lasted 8 weeks, and, of 96 patients, 17 dropped outprior to follow-up (none from future-oriented hypnosis, with the oth-ers equally divided between the other two conditions). The three treat-ments were equally effective in reducing headaches at posttreatment,but, after a 6- month follow-up period, the future-oriented hypnoticimagery that had been explicitly presented as hypnosis was found tobe superior to autogenic training. Contrary to common belief, it couldbe demonstrated that the therapists were as effective with the treatmentmodality they preferred as with the treatment modality they felt to beless remedial. They concluded, "Our data indicate that at least in tension CLINICAL HYPNOSIS AND HEADACHE REVIEW headache patients, defining a procedure explicitly as hypnotherapymay not lead to greater effects at posttreatment, but does lead to longerlasting effects" (p. 226).
Spinhoven, Linssen, Van Dyck, and Zitman (1992) compared manu- alized treatment with various self-hypnotic techniques or autogenictraining in 56 chronic tension-headache patients who had been evalu-ated by a neurologist. Patients served as their own controls with thefirst assessment session occurring after a wait-list period of 8 weeks.
There were no differences between treatment groups at conclusion oftreatment or at 6-month follow-up. Patients in both conditions signifi-cantly (p < .05) reduced their headaches and psychological distress(p < .05) (SCL-90; Derogatis, 1992) compared to the wait-list period.
Improvements were maintained at follow-up. Both long-term andshort-term pain reductions were accompanied by an increase in per-ceived pain control, and those patients attributing the pain reductionto their own efforts demonstrated long-term pain reduction.
In a randomized, controlled study, ter Kuile, Spinhoven, Linssen, Zitman, Van Dyck, and Rooijmans (1994) evaluated autogenic trainingin comparison to cognitive self-hypnosis training and a wait-list controlcondition in treating chronic headache patients. They also examined theinfluence of subject recruitment (neurological outpatient clinic or stu-dents or community members responding to a newspaper advertise-ment) on treatment outcome and whether level of hypnotizability wasrelated to outcome. Treatment consisted of seven individual manualizedtreatment sessions once weekly, with three reinforcement sessions at 2,4, and 6 months, with encouragement to use a 15-minute tape twicedaily. Cognitive self-hypnosis training included relaxation, imaginativeinattention, pain displacement and transformation, and hypnotic anal-gesia. Autogenic training was an extended version of previous studiesby this group, with standard autogenic exercises for arm heaviness, armwarming, steady and regular heartbeat, easy breathing, pelvic warmingand relaxation, and comfortable coolness of the forehead. At the con-clusion of treatment, there was a significant (p < .004) reduction inHeadache Index scores for both treatment groups compared with thewait-list controls, and no significant differences were observed betweenthe two conditions or the three referral sources. At 35-week follow-up,the improvements were maintained and there were also no significantdifferences between the treatment groups on the Headache Index, medi-cation usage, or in referral sources. In both treatment conditions, thehigh hypnotizable subjects achieved a greater reduction in headachepain at posttreatment and follow-up than did the low hypnotizable sub-jects. The authors speculated that because the autogenic training usedin this study was more extended and may have tapped more specificimagery and hypnotic skills, this may have been the reason for the rela-tionship with hypnotizability, in contrast to a previous study (Van Dyck D. CORYDON HAMMOND et al., 1991), which did not find such a relationship. It was concludedthat "simple and more complex procedures yield comparable therapyresults" (p. 357) and that "apparently, presenting multiple strategies tosubjects, including cognitive stress and pain coping strategies, did notenhance the efficacy of treatment" (p. 338).
There have also been other studies of autogenic training that found it equivalent to progressive relaxation (Friedman & Taub, 1984, 1985;Janssen & Neutgens, 1986), to biofeedback (thermal or EMG) (Friedman& Taub, 1984, 1985; Labbe, 1995; Sargent, Solbach, Coyne, Spohn, &Segerson, 1986), or to autogenic training combined with biofeedback(Labbe) in significantly reducing migraine or tension headaches. TheLabbe study with migraines in children was randomized, included await-list control group and 6-month follow-up, and found significantreductions in headache frequency (p < .01) compared with wait-list chil-dren. Friedman and Taub (1984, 1985) also used randomized assignmentto biofeedback, relaxation, and wait-list control groups compared withhigh and low hypnotizability groups. Cott, Parkinson, Fabich, Bedard,and Marlin (1992) found that autogenic training combined with EMGbiofeedback was significantly more effective than autogenic trainingalone or autogenic training combined with thermal biofeedback. Onestudy (Collet, Cottraux, & Juenet, 1986) did not find autogenic trainingsignificant in comparison with galvanic skin response biofeedback, butthe autogenic training was only administered via a tape recording. In arandomized study (Reich, 1989) in which autogenic training was used insome cases along with cognitive therapy, hypnosis, or progressive relax-ation in comparison to thermal or EMG biofeedback versus transcutane-ous electrical nerve stimulator (TENS) or cerebral electrical stimulationversus a multimodal treatment combining several of these modalities,there were significant pre-, posttreatment, and follow-up reductions oftension and migraine headaches and over-the-counter medication in allgroups. Finally, still one other study (Schlutter, Golden, & Blume, 1980)found equivalence in outcomes with tension headaches using hypnosis,EMG biofeedback, or EMG biofeedback combined with progressivemuscle-relaxation training. The basic equivalency of biofeedback andautogenic training in the treatment of headache or migraine that hasbeen noted in these more recent studies continues to provide furthersupport for the same conclusions reached in an older meta-analysis(Blanchard, Andrasik, Ahles, Teders, & O'Keefe, 1980) of 35 studies.
SUMMARY AND CONCLUSIONS Chambless et al. (1998) established the following criteria to obtain the status of a "well-established treatment." First, there must be at least twoexperiments that show efficacy through demonstrating (a) that it is supe-rior statistically to another treatment or to a pill or psychological placebo CLINICAL HYPNOSIS AND HEADACHE REVIEW or (b) that it is "equivalent to an already established treatment in experi-ments with adequate sample sizes" (p. 4). Alternatively, a treatment maybe considered well established through "a large series of single casedesign experiments (n > 9) demonstrating efficacy" (p. 4) that must haveused good experimental designs and compared the treatment to anotherintervention. Further, a well-established treatment must have been con-ducted with a treatment manual, clearly specify the characteristics of theclient samples, and the positive outcomes must have been demonstratedby at least two different investigators or research teams.
According to these standards for judging efficacy of clinical psy- chology treatments, the use of hypnosis with headaches and migrainesqualifies as a well-established treatment that is both efficacious andspecific. The efficacy of hypnosis with headaches has been demon-strated to be statistically superior or equivalent in comparison withcommonly used medication treatments, in a double-blinded placebo-controlled study, in comparison to established biofeedback treatments,and in research performed by many different investigators. The con-sensus of the outcome studies is that hypnotically facilitated relaxationand imagery (or imagery-modification) techniques, combined withencouraging the daily practice of self-hypnosis (e.g., with assistance ofa self-hypnosis tape), are usually effective without requiring morecomplex or multifaceted hypnotic techniques. The hypnotic methodol-ogy of using a series of structured and extended autogenic trainingexercises seems equivalent to other self-hypnotic techniques.
It should be noted that in my almost 30 years of clinical experience, it has likewise been invaluable to inquire about the frequency withwhich the patient awakens in the morning with a headache ormigraine. When this is a frequent occurrence, a self-hypnosis tape (thatis left open-ended at its conclusion) can be used at bedtime to promotecalming and deep relaxation, with repetitive suggestions that As you sleep, your jaw will remain relaxed and at ease throughout thenight, free from tension and tightness. And if there is a need to clenchanything, your mind will cause you to clench a hand into a fist, but yourjaw will remain loose and limp, relaxed and at ease as you sleep.
Hypnosis for bruxism and clenching has been documented to have sig- nificant effectiveness (Clarke & Reynolds, 1991) in reducing EMG activity.
The issue of whether there is a relationship between hypnotizability and outcome in the treatment of headache still remains unclear. Sev-eral studies have failed to find a correlation between hypnotizabilityand treatment outcome (Primavera & Patterson, 1991; Smith, Womack, &Chen, 1989; Spanos et al., 1993), while others have found a positiverelationship between hypnotizability and headache-treatment outcome(Andreychuk & Skriver, 1975; Friedman & Taub, 1984; ter Kuile et al.,1994; Van Dyck et al., 1991).
D. CORYDON HAMMOND In conclusion, not only has hypnosis been shown to be efficacious with headache and migraine but it is also a treatment that is relativelybrief and cost effective. At the same time, it has been found to be virtu-ally free of the side effects, risks of adverse reactions, and the ongoingexpense associated with the widely used medication treatments. Hyp-nosis should be recognized by the scientific, health care, and medicalinsurance communities as being an efficient evidence-based practice.
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Überblick über die Wirksamkeit von Klinischer Hypnose bei
Kopfschmerzen und Migräne
D. Corydon Hammond
Zusammenfassung: Die 12-köpfige Kommission des National Institute of
Health Technology Assessment für die Integration von behavioralen und
D. CORYDON HAMMOND entspannungsorientierten Ansätzen bei der Behandlung von chronischem
Schmerz und Insomnie (1996) hat die Forschungsergebnisse hinsichtlich des
Einsatzes von Hypnose bei Krebsschmerzen beurteilt und festgestellt dass
die Beweislage sehr günstig sei. Darüber hinaus gebe es weitere Hinweise
für die Effektivität von Hypnose bei einigen Formen von chronischem
Schmerz, darunter Spannungskopfschmerzen. Dieser Bericht liefert einen
aktualisierten Überblick über die vorhandene Literatur hinsichtlich der
Wirksamkeit von Hypnose bei der Behandlung von Kopfschmerzen und
Migräne und kommt zu dem Schluss, dass Hypnose die klinisch-
psychologischen Forschungskriterien einer gut etablierten und wirksamen
Therapieform erfüllt. Zugleich ist Hypnose praktisch frei von
Nebenwirkungen, Risiken von ungünstigen Reaktionen und den laufenden
Kosten pharmakologischer Behandlungen.
RALF SCHMAELZLE University of Konstanz, Konstanz, Germany Revue de l'efficacité de l'hypnose clinique dans le traitement de
maux de tête et de migraines
D. Corydon Hammond
Résumé: Les 12 membres du groupe de spécialistes du NIH (National
Institute of Health) pour l'évaluation technologique de l'intégration de la
relaxation et de méthodes comportementales dans le traitement de la
douleur chronique et de l'insomnie (1996) ont examiné des études portant
sur l'issue d'hypnothérapies contre la douleur liée au cancer et en ont conclu
que certains résultats étaient probants, alors que d'autres démontraient que
l'hypnothérapie peut être efficace pour traiter certaines douleurs
chroniques, notamment les céphalées de tension. Cet article fournit une
étude à jour de la documentation existante sur l'efficacité de l'hypnose dans
le traitement de maux de tête et de migraines, et conclut que l'hypnose
satisfait aux critères de recherche psychologique clinique en matière de
traitement efficace et bien établi, et qu'elle permet d'éviter presque
totalement les effets secondaires, les risques d'effets indésirables et les
dépenses à long terme associés à la prise de médicaments.
JOHANNE REYNAULT C. Tr. (STIBC) Revisión de la eficacia de la hipnosis clínica para los
dolores de cabeza y migrañas
D. Corydon Hammond
Resumen: Los 12 miembros del panel de la National Institute of Health
Technology Assessment sobre la integración de enfoques conductuales y de
relajación para el tratamiento de insomnio y dolor crónico (1996) revisaron
los estudios de hipnosis para el dolor de cáncer y concluyeron que la
evidencia de la investigación era fuerte y que otra evidencia sugiere que la
hipnosis puede ser efectiva para dolores crónicos, incluyendo los dolores de
CLINICAL HYPNOSIS AND HEADACHE REVIEW cabeza de tensión. Este artículo es una revisión actualizada de la literatura
sobre la eficacia de la hipnosis en el tratamiento de dolores de cabeza y
migrañas, y concluye que la evidencia reúne los criterios clínicos de
investigación en psicología de un tratamiento eficaz y bien establecido,
virtualmente libre de efectos secundarios, riesgos de reacciones adversas, y
gastos asociados con los tratamientos por medicación.
ETZEL CARDEÑA University of Lund, Lund, Sweden
AGGIORNAMENTI IN MEDICINA VETERINARIA :questioni di clinica medica degli animali da compagnia Diagnosi caso 1: Il cane magro con il "pancione": un segno, tante cause Grazie alla raccolta anamnestica, la visita clinica e le indagini collaterali è stato possibile raggiungere la diagnosi di sospetto: epatite cronica di origine tossica causata dall'ingestione di parti velenose di Cycas Revoluta. Le epatiti croniche del cane, sono processi flogistici che si sviluppano principalmente a livello del parenchima epatico, con il conseguente innalzamento dei valori delle transaminasi. Si tratta di patologie che si riscontrano soprattutto in cani di età adulta (4-7 anni) ad eccezione delle forme ereditarie da accumulo di rame che possono insorgere anche in soggetti più giovani; risultano maggiormente interessate le femmine, e, pur potendo interessare tutte le razze, esiste maggiore predisposizione per Bedlington Terrier, Dalmata, Labrador Retriever, Whest Highland White Terrier, Dobermann e Spaniel. Dal punto di vista sintomatologico, i cani affetti da epatite cronica possono presentarsi asintomatici o con segni clinici del tutto aspecifici, quali poliuria e polidipsia, anoressia/disoressia, dimagramento, abbattimento e intolleranza agli sforzi, vomito, diarrea e nei, casi gravi, ascite, coagulopatie ed encefalopatia epatica. La visita clinica del paziente raramente porta al riscontro di qualche reperto indicativo ad eccezione di uno scadimento delle condizioni generali del soggetto, o condizioni più eclatanti come ittero o ascite. Anche le alterazioni di laboratorio risultano non sempre indicative: si riscontrano di norma aumenti delle transaminasi , meno costanti aumenti di fosfatasi alcalina e γ-glutamiltransferasi; nelle fasi avanzate è poi possibile evidenziare tutte le alterazioni indicative di un malfunzionamento epatico, come ipoalbuminemia, riduzione dei valori dell'urea, aumento degli acidi biliari, abbassamento del fibrinogeno. Tra le alterazioni ematologiche che si possono incontrare, ci sono lieve anemia, leucocitosi e piastrinopenia (da consumo, in associazione a coagulopatia) oltre all'aumento dei tempi coagulativi (tempo di protrombina (PT), e tempo di tromboplastina parziale, PTT). La diagnostica per immagini, ed in particolare l'ecografia addominale, può solo completare il quadro ma non fornisce la diagnosi di certezza, in quanto possono sia essere evidenziate alterazioni nella struttura epatica, soprattutto in caso di cirrosi, ma non necessariamente soggetti affetti da epatite cronica presentano alterazioni dell'ecostruttura rilevabili all'esame. Lo strumento diagnostico più indicato in caso di tali patologie, è rappresentato dall'esame istopatologico di un campione prelevato tramite biopsia (ovviamente va ricordato che, in caso di patologia avanzata, in cui fossero comparsi deficit coagulativi, quest'ultima risulta controindicata). Nel presente caso l'esame bioptico ed istopatologico non è stato eseguito in quanto il proprietario non ha dato il suo consenso alla procedura perché preoccupato degli elevati rischi anestesiologici dovuti alla grave condizione clinica del suo cane.