Virtual reality and hypnosis for anxiety and pain management in intensive care units: A prospective randomised trial among cardiac surgery patients

Floriane Rousseaux, Nadia Dardenne, Paul B Massion, Didier Ledoux, Aminata Bicego, Anne-Françoise Donneau, Marie-Elisabeth Faymonville, Anne-Sophie Nyssen, Audrey Vanhaudenhuyse, Floriane Rousseaux, Nadia Dardenne, Paul B Massion, Didier Ledoux, Aminata Bicego, Anne-Françoise Donneau, Marie-Elisabeth Faymonville, Anne-Sophie Nyssen, Audrey Vanhaudenhuyse

Abstract

Background: Virtual reality and hypnosis are little studied in complex contexts, such as intensive care, where patients need significant physical and psychological assistance.

Objectives: To compare and combine hypnosis and virtual reality benefits on anxiety and pain on patients before and after cardiac surgery.

Design: Prospective randomised controlled clinical trial.

Setting: The study was conducted in the University Hospital of Liege (Belgium) from October 2018 to January 2020.

Patients: One hundred patients (66 ± 11.5 years; 24 women, 76 men) were included. Participants were adults undergoing cardiac surgery. Exclusion criteria: psychiatric diseases, claustrophobia, acrophobia, hearing loss, visual impairment, extreme fatigue, confusion surgery cancelled.

Interventions: Patients were randomly assigned to four arms (control; hypnosis; virtual reality; virtual reality hypnosis) and had 20 min of one of the techniques the day before and the day after surgery.

Main outcomes measures: Anxiety, pain, fatigue, relaxation, physiological parameters, and opioid use were evaluated before and after each session.

Results: The main results did not show any significant differences between the groups. In all groups, anxiety decreased and pain increased from baseline to the postoperative day. Relaxation increased in all groups in the pre-operative (P < 0.0001) and postoperative period (P = 0.03). There were no significant differences for fatigue, physiological measures, or opioid use.

Conclusion: As there were no significant differences between groups for the measured variables, we cannot affirm that one technique is better than another. Additional studies are required to compare and evaluate the cost-effectiveness of these techniques for critical care patients and caregivers.

Trial registration: ClinicalTrials.gov: NCT03820700. https://ichgcp.net/clinical-trials-registry/NCT03820700. Retrospectively registered on 29 January 2019.

Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

Figures

Fig. 1
Fig. 1
Virtual reality and virtual reality hypnosis landscape designed by Oncomfort
Fig. 2
Fig. 2
Study design, times and assessments
Fig. 3
Fig. 3
CONSORT flow diagram
Fig. 4
Fig. 4
Evolution of anxiety during presurgery and postsurgery (by time by group)
Fig. 5
Fig. 5
Evolution of pain during presurgery and postsurgery (by time by group)
Fig. 6
Fig. 6
Evolution of fatigue during presurgery and postsurgery (by time by group)
Fig. 7
Fig. 7
Evolution of relaxation during presurgery and postsurgery (by time by group)

References

    1. Akgul A, Guner B, Çirak M, et al. . The beneficial effect of hypnosis in elective cardiac surgery: a preliminary study. Thorac Cardiovasc Surg 2016; 64:581–588.
    1. Ganry L, Hersant B, Sidahmed-Mezi M, et al. . Using virtual reality to control preoperative anxiety in ambulatory surgery patients: a pilot study in maxillofacial and plastic surgery. J Stomatol Oral Maxillofac Surg 2018; 119:257–261.
    1. Johansen A, Romundstad L, Nielsen C, et al. . Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain 2012; 153:1390–1396.
    1. Mavros MN, Athanasiou S, Gkegkes ID, et al. . Do psychological variables affect early surgical recovery? PLoS One 2011; 6:e20306.
    1. Rovai D, Giannessi D, Andreassi M, et al. . Mind injuries after cardiac surgery. J Cardiovasc Med (Hagerstown) 2015; 16:844–851.
    1. Ames N, Shuford R, Yang L, et al. . Music listening among postoperative patients in the intensive care unit: a randomized controlled trial with mixed-methods analysis. Integr Med Insights 2017; 12:117863371771645.
    1. Lang EV, Benotsch EG, Fick LJ, et al. . Adjunctive nonpharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000; 355:1486–1490.
    1. Meurisse M, Hamoir E, Defechereux T, et al. . Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism? Ann Surg 1999; 229:401–408.
    1. Faymonville ME, Fissette J, Mambourg PH, et al. . Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg Anesth 1995; 20:145–151.
    1. Grégoire C, Nicolas H, Bragard I, et al. . Efficacy of a hypnosis-based intervention to improve well being during cancer: a comparison between prostate and breast cancer patients. BMC Cancer 2018; 18:677.
    1. Indovina P, Barone D, Gallo L, et al. . Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain 2018; 34:858–877.
    1. Patterson DR, Jensen MP, Wiechman SA, et al. . Virtual reality hypnosis for pain associated with recovery from physical trauma. Int J Clin Exp Hypn 2010; 58:288–300.
    1. Vanhaudenhuyse A, Gillet A, Malaise N, et al. . Psychological interventions influence patients’ attitudes and beliefs about their chronic pain. J Tradit Complement Med 2018; 8:296–302.
    1. Elkins GR, Barabasz AF, Council JR, et al. . Advancing research and practice: the revised APA division 30 definition of hypnosis. Int J Clin Exp Hypn 2015; 63:1–9.
    1. Spiegel D. Neurophysiological correlates of hypnosis and dissociation. J Neuropsychiatry Clin Neurosci 1991; 3:440–445.
    1. Faymonville ME, Meurisse M, Fissette J. Hypnosedation: a valuable alternative to traditional anaesthetic techniques. Acta Chir Belg 1999; 99:141–146.
    1. Ashton RC, Whitworth GC, Seldomridge JA, et al. . The effects of self-hypnosis on quality of life following coronary artery bypass surgery: preliminary results of a prospective, randomized trial. J Altern Complement Med 1995; 1:285–290.
    1. de Klerk JE, du Plessis WF, Steyn HS, et al. . Hypnotherapeutic ego strengthening with male South African coronary artery bypass patients. Am J Clin Hypn 2004; 47:79–92.
    1. Faymonville EM, Mambourg HP, Joris J, et al. . Psychological approaches during conscious sedation. Hypnosis versus stress reducing strategies: a prospective randomized study. Pain 1997; 73:361–367.
    1. Schnur JB, Kafer I, Marcus C, et al. . Hypnosis to manage distress related to medical procedures: a meta-analysis. Contemp Hypn 2008; 25:114–128.
    1. Bryson S. Virtual reality: a definition history - a personal essay. ArXiv13124322 Cs. 2013. Available at: . [Accessed 13 May 2020]
    1. Patterson DR, Wiechman SA, Jensen M, et al. . Hypnosis delivered through immersive virtual reality for burn pain: a clinical case series. Int J Clin Exp Hypn 2006; 54:130–142.
    1. Mosso-Vázquez JL, Gao K, Wiederhold BK, et al. . Virtual reality for pain management in cardiac surgery. Cyberpsychology Behav Soc Netw 2014; 17:371–378.
    1. Patterson DR, Tininenko JR, Schmidt AE, et al. . Virtual reality hypnosis: a case report. Int J Clin Exp Hypn 2004; 52:27–38.
    1. Oneal BJ, Patterson DR, Soltani M, et al. . Virtual reality hypnosis in the treatment of chronic neuropathic pain: a case report. Int J Clin Exp Hypn 2008; 56:451–462.
    1. Ong TL, Ruppert MM, Akbar M, et al. . Improving the intensive care patient experience with virtual reality—a feasibility study. Crit Care Explor 2020; 2:e0122.
    1. Rousseaux F, Bicego A, Ledoux D, et al. . Hypnosis associated with 3D immersive virtual reality technology in the management of pain: a review of the literature. J Pain Res 2020; 13:1129–1138.
    1. Enea V, Dafinoiu I, Opriş D, et al. . Effects of hypnotic analgesia and virtual reality on the reduction of experimental pain among high and low hypnotizables. Int J Clin Exp Hypn 2014; 62:360–377.
    1. Patterson DR, Hoffman HG, Palacios AG, et al. . Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. J Abnorm Psychol 2006; 115:834–841.
    1. Rousseaux F, Faymonville M-E, Nyssen A-S, et al. . Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial. Trials 2020; 21:330.
    1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet 1974; 304:81–84.
    1. Sessler CN, Gosnell MS, Grap MJ, et al. . The Richmond agitation–sedation scale. Am J Respir Crit Care Med 2002; 166:1338–1344.
    1. Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis 1986; 174:727–735.
    1. Rousseaux F, Bicego A, Malengreaux C, et al. . Can hypnosis be used in intensive care units? Méd Intensive Réa 2020; 29:309–318.
    1. Montgomery GH, Bovbjerg DH, Schnur JB, et al. . A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. J Natl Cancer Inst 2007; 99:1304–1312.
    1. K. Szilágyi A, Diószeghy C, Benczúr L, et al. . Effectiveness of psychological support based on positive suggestion with the ventilated patient. Eur J Ment Health 2007; 2:149–170.
    1. Bicego A, Monseur J, Rousseaux F, et al. . Drop-out from chronic pain treatment programmes: is randomization justified in biopsychosocial approaches? J Rehabil Med 2021; 53:jrm00185.
    1. Baños RM, Botella C, Garcia-Palacios A, et al. . Presence and reality judgment in virtual environments: a unitary construct? Cyberpsychol Behav 2000; 3:327–335.
    1. Wang L, Chang Y, Kennedy SA, et al. . Perioperative psychotherapy for persistent postsurgical pain and physical impairment: a meta-analysis of randomised trials. Br J Anaesth 2018; 120:1304–1314.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren