Aminata Bicego

Background: Port-a-catheter (PAC) placement is a common procedure in oncology that, despite local anaesthesia, can induce patient discomfort, procedural pain, and anxiety. Virtual reality hypnosis (VRH), combining immersive virtual reality with clinical hypnosis, has been proposed as a non-pharmacological adjunct to reduce peri-procedural distress. Objectives: This pilot study aimed to explore the suitability of VRH during PAC placement and its potential effects on pain, anxiety, and VRH-related experiences, while investigating psychological variables associated with VRH engagement. Methods: In this single-arm interventional monocentric prospective pilot study, twenty oncology patients undergoing first-time elective PAC placement received a VRH intervention delivered via a medical-grade head-mounted display throughout the procedure. Pain, anxiety, and VRH-related dimensions—including absorption, dissociation, automaticity, arousal, and sense of presence—were assessed pre- and post-procedure using self-reported numerical rating scales and questionnaires. Non-parametric Wilcoxon tests evaluated pre–post changes, and correlational analyses (Pearson’s and Spearman’s when necessary) explored associations between variables. Results: VRH was well tolerated by most participants, although three patients required additional pharmacological support, and four could not complete the session due to intolerance or technical issues. Anxiety scores decreased significantly following VRH, whereas pain showed a non-significant trend toward reduction. Post-procedural absorption and dissociation were positively associated with presence, and higher absorption traits were linked to greater immersive engagement and prior VR/hypnosis experience. Cybersickness was negatively associated with absorption. Older age was correlated with lower post-procedural pain, and females reported higher state anxiety. Conclusions: In this pilot, VRH was feasible, well tolerated, and associated with a significant exploratory reduction in procedural state anxiety. Given the single-arm design, these findings constitute directional evidence warranting controlled trial evaluation rather than proof of efficacy. These preliminary results support the rationale for randomised controlled trials to evaluate VRH efficacy, underlying mechanisms, and potential role as a non-pharmacological adjunct in oncology perioperative care.

Background/Objectives: Hypnosis shows great potential for managing patients suffering from fibromyalgia and chronic pain. Several studies have highlighted its efficacy in improving pain, quality of life, and reducing psychological distress. Despite its known feasibility and efficacy, the mechanisms of action remain poorly understood. Building on these insights, this innovative study aims to assess neural activity during hypnosis in fibromyalgia patients using high-density electroencephalography (EEG) and self-reported measures. Methods: Thirteen participants with fibromyalgia were included in this study. EEG recordings were done during resting state and hypnosis conditions. After both conditions, levels of pain, comfort, absorption, and dissociation were assessed using a numerical rating scale. Time perception was collected via an open-ended question. The study was prospectively registered in the ClinicalTrials.gov public registry (NCT04263324). Results: Neural oscillations showed increased theta power during hypnosis in the left parietal and occipital electrodes, increased beta power in the frontal and left temporal electrodes, and increased slow-gamma power in the frontal and left parietal electrodes. Functional connectivity using pairwise-phase consistency measures showed decreased connectivity in the frontal electrodes during hypnosis. Graph-based measures, the node strength, and the cluster coefficient were lower in frontal electrodes in the slow-gamma bands during hypnosis compared to resting state. Key findings indicate significant changes in neural oscillations and brain functional connectivity, suggesting potential electrophysiological markers of hypnosis in this patient population.

When used separately, virtual reality (VR) and mind-body therapies (MBTs) have the potential to reduce pain across various acute and chronic conditions. While their combination is increasingly used, no study offers a consolidated presentation of VR and MBTs. This study aims to propose an overview of the effectiveness of VR combined with MBTs (i.e., meditation, mindfulness, relaxation, and hypnosis) to decrease the pain experienced by healthy volunteers or patients. We conducted a scoping review of the literature using PubMed, Science Direct and Google Scholar and included 43 studies. Findings across studies support that VR combined with MBTs is a feasible, well-tolerated, and potentially useful to reduce pain. Their combination also had a positive effect on anxiety, mood, and relaxation. However, insufficient research on this VR/MBTs combination and the lack of multidimensional studies impede a comprehensive understanding of their full potential. More randomized controlled studies are thus needed, with usability evaluation protocols to better understand the effects of VR/MBTs on patients wellbeing and to incorporate them into routine clinical practice.

Modern medicine has been shaken by the surge of psychedelic science that proposes a new approach to mitigate mental disorders, such as depression and post-traumatic stress disorder. Clinical trials to investigate whether psychedelic substances can treat psychiatric conditions are now underway, yet less discussion gravitates around their use in neurological disorders due to brain injury. One suggested implementation of brain-complexity enhancing psychedelics is to treat people with post-comatose disorders of consciousness (DoC). In this article, we discuss the rationale of this endeavour, examining possible outcomes of such experiments by postulating the existence of an optimal level of complexity. We consider the possible counterintuitive effects of both psychedelics and DoC on the functional connectivity of the default mode network and its possible impact on selfhood. We also elaborate on the role of computational modelling in providing complementary information to experimental studies, both contributing to our understanding of the treatment mechanisms and providing a path towards personalized medicine. Finally, we update the discourse surrounding the ethical considerations, encompassing clinical and scientific values.

Background: The management of chronic pain may involve an array of tools, including radiofrequency thermocoagulation (Rf-Tc) of sensory nerve terminals. Like many other invasive procedures, Rf-Tc can generate anxiety in a lot of patients, either during the expectation of the procedure or in the course of it. Virtual reality hypnosis (VRH) is a promising tool for managing anxiety and pain in several situations, but its anxiolytic property has not been investigated in participants with chronic pain and going through a Rf-Tc procedure.Objectives: The goal of this study was to evaluate the effectiveness of VRH for reducing self-assessed anxiety in participants with chronic pain, when received in preparation for Rf-Tc.Materials and methods: This prospective, controlled trial was conducted in the Interdisciplinary Algology Centre of the University Hospital of Liège (Belgium). Participants were assigned to two groups: VRH or control (usual care). Assessment was carried-out at 4 time points: T0 (one week before Rf-Tc); T1 (pre-intervention, on the day of Rf-Tc); T2 (immediately after the VRH intervention outside of the Rf-Tc room); and T3 (right after Rf-Tc). Medical, sociodemographic data, anxiety trait and immersive tendencies were collected at T0. Anxiety state and pain intensity were assessed at each time points. Satisfaction was examined at T3.Results: Forty-two participants were quasi-randomly assigned to the VRH or control group. No statistically significant interaction group by time was observed regarding all measured variables, including primary endpoint. However, a significant effect of time was found for anxiety and pain when considering both groups together, toward a progressive reduction.Conclusion: In the context of our study, there appears to be no significant effect of VRH at reducing anxiety in participants with chronic pain undergoing Rf-Tc. Anxiety decreases along the procedure, while pain is attenuated by the local anesthetic infiltration of the Rf site. Our results suggest that the presence of a caregiver throughout the procedure might explain the progressive decrease in anxiety. Future randomized controlled trials are needed to precisely study the effectiveness of the VRH tool, and the possibility of using it as a complementary approach for anxiety during invasive procedures.

Background: Virtual reality hypnosis (VRH) has emerged as a new and promising option for pain management. Nonetheless, neural dynamics of pain modulation during VRH have not been investigated yet. The aim of this study was to measure the effects of VRH on pain, combining neurophysiological and self‐reported measurements.Methods: Eighteen healthy subjects underwent noxious electrical stimulations in both normal wakefulness and VRH conditions. Dissociation, absorption, time perception, anxiety, pain intensity and unpleasantness, heart rate variability and breathing were reported for each condition. EEG signals were analysed using event‐related potentials (ERP) and time–frequency response (TFR) time‐locked to stimuli. Neurophysiological features were correlated with self‐reported data.Results: VRH condition was associated with lower pain and higher dissociation. VRH significantly decreased amplitudes of N100 and P200 ERP components, reduced EEG power between 1 and 5 Hz from 100 to 560 ms, and increased EEG power from 5 to 11 Hz from 340 to 800 ms. These findings were observed at frontal, central and posterior electrodes. Heart rate variability was significantly higher and breathing frequency reduced with VRH. Correlations were found between the self‐reported level of pain and ERP components.Conclusion: VRH modulates cerebral pain processes and body physiology, leading to reduced pain levels. These findings offer a first insight on the analgesic mechanisms of VRH and suggest that VRH is an effective approach to reduce experimental pain.Significance: VRH decreases experimental pain perception, increases subject level of dissociation and modulates cerebral pain processing mechanisms. Pain can be managed with analgesic medication but also through complementary interventions. Among these, hypnosis and virtual reality (VR) are known to reduce pain for patients and healthy individuals. In recent years, an innovative technique combining hypnosis and VR has been proposed to help patients in managing pain. However, to our knowledge, no study has focused on the underlying mechanisms of this VR/hypnosis combination. We showed that VR combined with hypnosis decreases experimental pain, increases dissociation and influences EEG modulation.

Phantom limb pain occurs in more than half of the people who have undergone an amputation. Hypnosis can alleviate pain effectively in experimental, procedural, and chronic pain. Thus, in this multiple-case study, we determined whether hypnosis might be a successful complementary approach to help patients with phantom limb pain in alleviating their pain quality (i.e., sensitive and affective), intensity, fatigue, and emotional distress (i.e., anxiety and depression). Seven patients experiencing phantom limb pain were trained to perform self-hypnosis in five sessions over two and a half months. The patients were encouraged to practice at home daily throughout the study. Measures of the intensity of pain and fatigue, the severity of insomnia, anxiety, depression, and the quality of pain (i.e., sensitive and affective) were performed before and after self-hypnosis training. Six years after the completion of the study, the patients were contacted over the telephone to follow up on their practice of self-hypnosis. All patients reported a reduction in the intensity of pain, severity of insomnia, anxiety, and quality of pain. They also reported a positive change in their behaviors and the sensation of pain after performing hypnosis. At the six-year follow-up, three patients were still practicing hypnosis and reported better control over pain and being more relaxed. The main reason for most patients to stop practicing self-hypnosis was that they failed to find the time. Self-hypnosis can effectively ameliorate pain, fatigue, and emotional distress in patients suffering from phantom limb pain. Large-sample clinical trials with a mixed design are needed to confirm these results.

Chronic pain is a complex phenomenon which includes biological, psychological, and socio-professional factors that undermine patients’ everyday life. Currently, only few patients significantly benefit from pharmacological treatments and many have to stop them because of negative side effects. Moreover, no medication or treatment addresses all aspects of chronic pain at once (i.e., sensations, emotions, behaviors, and cognitions), positioning chronic pain as an important public health issue and thus contributing to high health-care costs. Consequently, patients and health-care providers are increasingly turning to complementary non-pharmacological techniques such as hypnosis. Clinical research has demonstrated a decrease of pain perception, pain interference, depression and anxiety, and an increase in global quality of life when patients with chronic pain have benefited from hypnosis learning. Neuroimaging studies offer a possible explanation of these results by focusing on neural processes of pain modulation in chronic pain patients’ brain. Studies conducted with chronic pain patients showed a modulation of pain matrix activity during hypnosis with a specific involvement of the anterior cingulate cortex (related to emotional and cognitive processing of pain). Therefore, hypnosis seems to act upon regions underlying emotion and cognition, with an influence on pain perception and emotional regulation. In this review, we propose to carry out a review of the recent literature on hypnosis in chronic pain management. A better understanding of the beneficial effects of hypnosis on chronic pain and its neurophysiology should enable more systematic use of this technique in the management of this complex health problem.

Background: In chronic pain, it seems that the effect of cognitive-behavioral therapy (CBT) is boosted when it is combined with hypnosis. The aim of this study was to assess the efficacy of self-hypnosis combined with self-care (i.e., a type of CBT) compared to music/self-care, self-care and psychoeducation/CBT and to evaluate their long-term effects. Methods: An open label randomized clinical trial enrolled patients with chronic pain and was carried out at the University Hospital of Liège (Belgium). Patients were randomized into four groups: self-hypnosis/self-care, music/self-care, self-care, psychoeducation/CBT (7 monthly sessions of 2 hours). Two follow-up sessions were delivered at 6- and 12-month. Levels of pain, fatigue intensity, anxiety, depression, insomnia severity, disability, health locus of control, mental and physical quality of life and attitudes (control, disability, harm, emotion, medical cure, medication, solicitude) towards pain were assessed before and after the treatments, and at follow-up. Results: 203 patients were randomized: 52 in self-hypnosis/self-care, 59 in music/self-care, 47 in self-care, and 45 in psychoeducation/CBT. No group effect was found. A significant time effect was showed. Directly after the treatment, all groups decreased in pain attitudes and physical quality of life. Perceived control increased. At 6-month, all patients kept their levels of physical quality of life and perceived control, and showed decrease in pain intensity, harm, emotion and medical cure. At 12-month, scores that had change previously remained ameliorated, a decrease in insomnia severity and an increase in internal locus of control were observed. Conclusions: The present findings are encouraging as they display long-term beneficial effects of complementary biopsychosocial-based treatments in chronic pain. It seems that patients continued to apply the learnt strategies as improvements were observed one year after the treatments had ended.

Objective: To identify profiles of patients who are at risk of dropping out from biopsychosocial app...