This study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and ...meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and nonrandomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery. After searching the databases from January 1980 to September 2016, a total of 62 RCTs were included with a pooled sample size of 4,908. Psychosocial interventions significantly reduced postoperative pain (Hedges' g = 0.31 95% confidence interval = 0.14, 0.48), and preoperative and postoperative anxiety (g = 0.26 0.11, 0.42 and g = 0.4 0.21, 0.59, respectively). Furthermore, psychosocial interventions improved recovery (g = 0.38 0.22, 0.54). However, no significant effects were found for postoperative analgesic use (g = 0.16 -0.01, 0.32) and quality of life (g = 0.14 -0.05, 0.33). Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The results indicate that psychosocial interventions, especially patient education and relaxation training, may reduce perioperative side effects and improve recovery in patients undergoing orthopedic procedures, but the quality of evidence is generally low. More well-powered, high-quality studies are needed to increase confidence. PERSPECTIVE: In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative pain, perioperative anxiety, and recovery were found, suggesting that psychosocial interventions, especially patient education and relaxation techniques, are useful in improving clinical care.
Changes in oxytocin and cortisol levels were tested in healthy volunteers during hypnotic interactions in standardized laboratory sessions. Pre- to posthypnosis changes of oxytocin and cortisol were ...related to the hypnotic susceptibility of subjects and the relational experiences reposted by subjects and hypnotists on several paper-and-pencil tests. Results show that the changes in oxytocin are not related to hypnotic susceptibility but to relational experiences. After the hypnotic interaction, the subject's oxytocin level increased if perceived harmony with the hypnotist was high, whereas it increased in the hypnotist if the subject had memories of less warm emotional relationships with his or her parents. The results are interpreted within the social-psychobiological model of hypnosis.
The present study explored presence of meaning in life, search for meaning in life, and their correlation with health anxiety. The Meaning in Life Questionnaire and the Short Health Anxiety Inventory ...were completed by 753 individuals. Results indicated higher presence of meaning in life was associated with lower health anxiety, while the opposite was observed for search for meaning in life. Results also revealed an interaction between presence of meaning in life and search for meaning in life, where individuals with high search for meaning in life and high presence of meaning in life had lower health anxiety than those with high search for meaning in life and low presence of meaning in life. These findings suggest that presence of meaning in life and search for meaning in life are correlates of health anxiety.
Exploring autonomic nervous system (ANS) changes during hypnosis is critical for understanding the nature and extent of the hypnotic phenomenon and for identifying the mechanisms underlying the ...effects of hypnosis in different medical conditions. To assess ANS changes during hypnosis, electrodermal activity and pulse rate variability (PRV) were measured in 121 young adults. Participants either received hypnotic induction (hypnosis condition) or listened to music (control condition), and both groups were exposed to test suggestions. Blocks of silence and experimental sound stimuli were presented at baseline, after induction, and after de‐induction. Skin conductance level (SCL) and high frequency (HF) power of PRV measured at each phase were compared between groups. Hypnosis decreased SCL compared to the control condition; however, there were no group differences in HF power. Furthermore, hypnotic suggestibility did not moderate ANS changes in the hypnosis group. These findings indicate that hypnosis reduces tonic sympathetic nervous system activity, which might explain why hypnosis is effective in the treatment of disorders with strong sympathetic nervous system involvement, such as rheumatoid arthritis, hot flashes, hypertension, and chronic pain. Further studies with different control conditions are required to examine the specificity of the sympathetic effects of hypnosis.
The low reproducibility rate in social sciences has produced hesitation among researchers in accepting published findings at their face value. Despite the advent of initiatives to increase ...transparency in research reporting, the field is still lacking tools to verify the credibility of research reports. In the present paper, we describe methodologies that let researchers craft highly credible research and allow their peers to verify this credibility. We demonstrate the application of these methods in a multi-laboratory replication of Bem's Experiment 1 (Bem 2011
, 407-425. (doi:10.1037/a0021524)) on extrasensory perception (ESP), which was co-designed by a consensus panel including both proponents and opponents of Bem's original hypothesis. In the study we applied direct data deposition in combination with born-open data and real-time research reports to extend transparency to protocol delivery and data collection. We also used piloting, checklists, laboratory logs and video-documented trial sessions to ascertain as-intended protocol delivery, and external research auditors to monitor research integrity. We found 49.89% successful guesses, while Bem reported 53.07% success rate, with the chance level being 50%. Thus, Bem's findings were not replicated in our study. In the paper, we discuss the implementation, feasibility and perceived usefulness of the credibility-enhancing methodologies used throughout the project.
Suggestive interventions such as hypnosis and therapeutic suggestions are frequently used to alleviate surgical side effects; however, the effectiveness of therapeutic suggestion intervention has not ...yet been systematically evaluated. In the present study, we tested the hypotheses that (1) suggestive interventions are useful for reducing postoperative side effects; (2) therapeutic suggestions are comparable in effectiveness to hypnosis; (3) live presentation is more effective than recordings; and (4) suggestive interventions would be equally effective used in minor and major surgeries.
We performed random effect meta-analysis with meta-regression and sensitivity analysis by moderating factors on a pool of 26 studies meeting the inclusion criteria (N = 1890). Outcome variables were postoperative anxiety, pain intensity, pain medication requirement, and nausea.
Suggestive interventions reduced postoperative anxiety (g = 0.40; 99% confidence interval CI = 0.13-0.66; P < 0.001) and pain intensity (g = 0.25; 99% CI = 0.00-0.50; P = 0.010), but did not significantly affect postoperative analgesic drug consumption (g = 0.16; 99% CI = -0.16 to 0.47; P = 0.202) and nausea (g = 0.38; 99% CI = -0.06 to 0.81; P = 0.026). No significant differences were found for intervention type, presentation method, and severity of surgery; however, sensitivity analysis only supported the effectiveness of hypnosis (g = 0.62; 99% CI = 0.31-0.92; P < 0.001) and live presentation (g = 0.55; 99% CI = 0.23-0.88; P < 0.001) for decreasing postoperative anxiety, and that of live presentation for alleviating postoperative pain (g = 0.44; 99% CI = 0.07-0.82; P = 0.002). Sensitivity analyses also suggested that suggestive interventions are only effective for decreasing pain intensity during minor surgical procedures (g = 0.39; 99% CI = 0.00-0.78; P = 0.009).
Suggestive techniques might be useful tools to alleviate postoperative anxiety and pain; however, strength of the evidence is weak because of possible bias in the reviewed articles. The lack of access to within-subjects data and the overlap between moderator conditions also limit the scope of the analysis. More methodologically correct studies are required with sensitivity to moderating factors and to within-subjects changes. For clinical purposes, we advise the use of hypnosis with live presentation to reduce postoperative anxiety and pain, until convincing evidence is uncovered for the effectiveness of therapeutic suggestions and recorded presentation. Pain management with adjunct suggestive interventions is mostly encouraged in minor rather than major surgeries.
Most real-world applications of hypnosis involve a pair of actors: a hypnotist and a subject. Accordingly, most current models of hypnosis acknowledge the relevance of social factors in the ...development of the hypnotic response. Yet, psychophysiological research on hypnosis has been mostly restricted to techniques that are studying one individual, neglecting the complexity of hypnosis as a social phenomenon. In this paper, we review evidence suggesting that a multi-brain approach to studying the psychophysiology of hypnosis could lead to a breakthrough in our understanding of the neural correlates of hypnosis. In particular, we aim to highlight how this approach which relies on the information conveyed by complex verbal stimuli can be utilized to deal with the multifaceted nature of hypnosis. Furthermore, we present analytical approaches to assessing brain-to-brain coupling developed in the field of social cognitive neuroscience in the past decade, to aid the design of similar multi-brain studies in hypnosis research.
Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from ...the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.
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