The Added Value of Intraoperative Hypnosis during Spinal Cord Stimulation Lead Implantation under Awake Anesthesia in Patients Presenting with Refractory Chronic Pain

Chantal Wood,Philippe Rigoard,Maxime Billot,Gaëlle Martiné,Lisa Goudman,Romain David,Karine Le Goff,Sandrine Baron,Gaëlle Espagne-Dubreuilh,Nicolas Naïditch,Maarten Moens

doi:10.3390/medicina58020220

Abstract

To improve pain relief for refractory pain condition, spinal cord stimulation (SCS) needs to target the dedicated neuronal fibers within the dorsal columns. Intraoperative feedback from the patient can optimize lead placement but requires “awake surgery”, allowing interaction between patient and surgeon. This can produce negative effects like anxiety and stress. To better manage these aspects, we propose to combine intraoperative hypnosis with awake anesthesia. Seventy-four patients (35 females, 22–80 years) presenting with chronic refractory pain, were offered intraoperative hypnosis during awake SCS lead implantation. Interactive conversational hypnosis was used as well as interactive touch, which was enhanced during painful moments during the lead intraoperative programming. All patients participated actively during the intraoperative testing which helped to optimize the lead positioning. They kept an extremely positive memory of the surgery and of the hypnotic experience, despite some painful moments. Pain could be reduced in these patients by using interactions and touch, which works on Gate Control modulation. Positive memory was reinforced by congratulations to create self-confidence and to induce positive expectations, which could reinforce the Diffuse Noxious Inhibitory Controls at the spinal level. Cooperation was improved because the patient was actively participating and thus, much more alert when feedback was required. Combining intraoperative hypnosis with awake anesthesia appears helpful for SCS lead implantation. It enhances patient cooperation, allows optimization of lead positioning, and leads to better pain control, positive and resourceful memory.

Highlights

Management of some refractory chronic pain conditions can be improved by using epidural Spinal Cord Stimulation (SCS) [1,2,3]
Dividual anatomical similarities exist, each patient has specific spinal cord anatomy, which means that optimal lead positioning varies from one patient to another and should benefit from direct intraoperative patient feedback whenever possible
All patients had a highly positive experience of hypnosis and of what had happened during the surgery, despite some painful moments

Summary

Introduction

Drome, persistent spinal pain syndrome, complex regional pain syndromes, neuropathic pain, etc.) can be improved by using epidural Spinal Cord Stimulation (SCS) [1,2,3]. Ventional SCS needs to target the dedicated neuronal fibers within the spinal cord dorsal columns in order to produce substantial pain relief [4]. Dividual anatomical similarities exist, each patient has specific spinal cord anatomy, which means that optimal lead positioning varies from one patient to another and should benefit from direct intraoperative patient feedback whenever possible. 1970s and are commonly used for brain tumor resection, allowing true and reversible interaction between patient and surgeon [5]. This concept can be transposed to SCS im‐

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