Hypnosis? Have you tried it?

Two cases of hypnotherapeutic treatment of psychogenic hyperhidrosis are presented. In both cases, organic aetiology could be excluded and conventional medical treatment modalities had no effect. In both cases, it was possible to modulate sweating in the trance state within less than a minute, thus supporting other reported cases of the effect of hypnotically induced modulation of autonomic responses. In the first case the psychological dynamics behind the physiological symptoms seemed unrelated to fundamental emotional and personal problems and relaxation and conditioning techniques in hypnosis had a positive effect in reducing the sweating to both objectively and subjectively socially acceptable standards. In the second case the hyperhidrosis was related to more fundamental personality problems and short term hypnotherapy proved ineffective in treating the condition.

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BACKGROUND: Injections of botulinum toxin type A are extremely effective in treating palmar hyperhidrosis. The main problem is pain during injections in the palms and pulp of the fingers. Anaesthesia of the hands using Emla and analgesia with an equimolar mixture of oxygen/nitrous oxide are occasionally disappointing. We analysed the value of hypnosis in reducing injection pain. PATIENTS AND METHODS: In a prospective study performed between September 2005 and September 2006, we offered a full session of hypnosis in order to relieve pain for patients presenting troublesome bilateral and palmar hyperhidrosis and requiring treatment by palmar injection of botulinum toxin. At the end of the hypnosis session, patients evaluated their pain on a scale of 0 to 10 and indicated whether or not the injections had been bearable. RESULTS: Of the 15 patients included, 13 underwent a hypnosis session. The mean pain scores following hypnosis were 2.52 and all patients considered their injections bearable. Six patients with a pain score of between 7 and 8 out of 10 during previous injections without analgesia or using Kalinox evaluated their pain as between 1 and 3 following hypnosis. DISCUSSION: Palmar injection of botulinum toxin is increasingly being used for hyperhidrosis patients. In dermatology, access to operating theatres or the presence of a trained anaesthetist is normally extremely difficult, and hypnosis appears to offer an extremely effective method of reducing the pain associated with such injections.

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