engleski

Using hypnosis to treat burn pain

U radu autori daju pregled suvremenih spoznaja o primjeni medicinske hipnoze u hospitalnom liječenju pacijenata s opeklinama. Kao česta i relativno uspješna metoda u otklanjanju i ublažavanju boli, medicinska hipnoza ima važno mjesto tijekom liječenja pacijenata s opeklinama u svim fazama hospitalnog liječenja. Novija literatura ukazuje na činjenicu da su upravo odjeli za opekline mjesta gdje se primjena medicinske hipnoze pokazala izrazito učinkovitom. Predvidive, bolne i složene procedure tijekom liječenja pacijenata, kao i njihova emocionalna stanja nakon traume, pravo su područje pimjene hipnotskih intervencija. Uz farmakoterapiju, hipnoza ublažava bol, smanjuje anksioznost, te utječe na fiziologiju vegetativnog sustava, smanjujući tako potrebu za analgeticima i sedativima. Danas postoje spoznaje o utjecaju hipnoze kako na smanjenje upale tako i na pozitivno djelovanju u procesu cjeljenja rane. Osim toga, hipnoza je značajna za pacijente u smislu njihovog iskustva veće kontrole u situacijama koje se često doživljavaju kao preplavljujuće i neizdržive. Većina pacijenata s opeklinama kojima je primjenjivana hipnoza pokazali su neki stupanj poboljšanja, a oko 10-20% pacijenata pokazalo je dramatične pomake, dok sličan postotak pacijenata nije reagirao u značajnijoj mjeri. Unatoč ovim važnim spoznajama i vrlo pozitivnim rezultatima dosadašnjih studija, hipnoza je uvelike zanemarena u liječenju opeklina. Potrebna su daljnja, sistematska i kontrolirana istraživanja kao potvrda i dodatak dostupnim kliničkim nalazima. Obzirom na suvremene svjetske spoznaje, smatramo nužnom potrebu edukacije stručnjaka i u našoj zemlji o primjeni medicinske hipnoze pri liječenju opeklina, kao važnom terapijskom čimbeniku. Nove reference ukazuju da trauma povezana s ozbiljnom opeklinom može utjecati na pojedince na razne načine: depresija, anksioznost i postraumatski stresni poremećaj (PTSP) relativno su uobičajene posljedice. Također, regresija pa i psihotični simptomi uzrokovani boli, iscrpljenošću i dezorijentiajućim efektom nekih lijekova nisu rijetke posljedice. Prema suvremenim svjetskim referencama, pacijent sa ozbiljnom opeklinom treba psihijatrijsku pomoć od trenutka ozljede do oporavka, a ova potreba je sve veća otkad su moderni centri za liječenje opeklina dramatično poboljšali stopu preživljavanja. Ova potreba za multidisciplinarnim pristupom, prepoznata u gotovo svim vodećim svjetskim centrima za liječenje opeklina, uključuje u integriranom psihijatrijskom pristupu kako racionalnu upotrebu psihofarmaka, tako i adekvatne psihoterapijske intervencije. Pacijenti s ozbiljnim opeklinama imaju u sebi jako puno negativnih emocija. Sama opeklina kao i način liječenja su jako bolni, pa se javlja i strah od idućeg tretmana. Nesreća se najčešće događa zbog nepažnje, pa su prisutni ili krivnja ili bijes. Osjećaj bespomoćnosti i beznađa dovodi do depresije. Curtiz Arts, prvi predsjednik American Burn Association i jedan od prvih zagovaratelja odvojenih centara za liječenje opeklina, rekao je slijedeće: &laquo ; Dobro motiviran pojedinac nosit će se dobro i nakon najozbiljnije opekline, dok će oni bez istoga imati značajnih poteškoća u oporavku… &raquo ; Whena a newly burned patient arrives in the Emergency Room, his mind is concentrated and hypnosis is easy to induce if he is not already in a spontaneous trance. He is often a stranger to the physician, and the forst communication is an introduction and suggestion: VERBALIZATION Doctor: I'm Dr____ and I'll be taking care of you (pause). Do you know how to trat this kind of burn? Patient: No. Comment: This question is to bring to his immediate attention that he does not know and that he must put his faith in the medical team. Precise wording is important because if you ask: &laquo ; Do you know anxthing about treating burns?' he may think he knows something and tell you about butter, Solarcaine , or kiss-it-and-make-it-well, which is complete avoidance of recognizing the dependence. Doctor:That's all right, because we know how to take care of this, and you've already done the most important thing, which was to get to the hospital quickly. You are safe now, and if you will do what I say, you can have a comfortable rest in the hospital while your body is healing. Will you do what I say? Patient: Yes (or I'll try). Comment: The standard reply. In the rare instance of a physician or nurse who actually does know about burns, you simply use that knowledge to say:&raquo ; Than you already know that you need to turn your care over to us and that we will take care of you&raquo ; . This exchange lets the patient know that he is on the team and has already done his biggest job, so he can safely lay aside his fight or flight response (he's already fled to the hospital). Which mobilizes hormones that interfere with normal immunity and metabolism. It includes a prehypnotic suggestion (Alexander, 1971) that he is safe and can be comfortable if he makes a commitment. With his affirmatve answer he has made a hypnotic contract that is as good as any trance. Frightened patients tend to constantly analyze each sensation and new symptom to report to the doctor. By turning his care over to us (the whole team), he is freed of his responsibility and worry. Next, his attention is diverted to something he had not thought of before. Doctor:The first thing I want you to do is turn the care of this burn completely over to us, so you wo't have to worry about it at all. The second thing is for you to realize that what you think will make a great deal of difference in your healing. Have you ever seen a person blush red, or blanch white with fear? Patient: Yes. Doctor: Well, you know that nothing has happened except a thought, an idea, and all of the little blood vessels in the face have opened up and turned red, or clamped down and blanched. What you think is going to affect the blood supply to your skin, and that affects healing, and you can start right now. You need to have happy, relaxing, enjoyable thoughts to free up all of your healing energy. Brer Rabbit said &laquo ; everybody's got a laughing place' and when I tell you to go to your laughing place, I mean for you to imagine that you are in a safe, peaceful place, enjoying yourself, totally free of responsibility, just goofing off. What would you choose for a laughing place? Comment: The patient needs something he perceives as useful to occupy his mind. The laughing place may be the beach, television, fishing, golfing, needlepoint, playing dolls, anything. It becomes the key word for subsequent rapid induction for dressing changes, and so on – to simply 'go to your laughing place'. Patient: Go to the beach… or… Doctor: Let's get you relaxed and go to youtr laughing place right now, while we take care of the burn. Get comfortable and roll your eyeballs up as though you are looking at the top of your forehead and take a deep, deep, deep breath and as you take it in, gradually close your eyelids, and as you let the breath out, let your eyes relax and let every nerve and fibre in your body go (slow and cadenced) loose and limp and lazy, your limbs like lumps of lead. Then just let your mind go off to your laughing place and… (visual imagery of laughing pace). Comment: It helps the doctor to know what the laughing place is and to record it, because he may enhance it later with some visual imagery. This simple rapid induction usually produces a profoud trance almost immediately. Doctor: Now while you are off at your laughing place, I want you to also notice that all of the injured areas are cool and comfortable. Notice how cool and comfortable they actually are, and when you can really feel this, you'll let me know because this finger (touch an indeks finger) will slowly rise to signal that all of the injured areas are cool and comfortable. Comment: By this time, the patient has iced towels on and the analgesic is taking effect so that he actually is cool and comfortable. It is much easier hypnotically to continue a sensation that is already present that it is to imagine its opposite. The suggestion &laquo ; cool and comfortable&raquo ; is anti-inflammatory, and if he accepts it, he cannot be hot and painful. From now on, the word injured is substituted whenever possible for the word burn, because patient use the word burning to describe their pain (Do not specify a particular area such as hand, neck, etc., because while this areas may do well, some area you forgot may do poorly.)

burn pain; hypnosis

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