催眠可缓解重度绝经后潮热

新奥尔良(EGMN)——在美国行为医学学会(SBM)年会上报告的一项随机对照试验表明，催眠治疗可使绝经后潮热发作频率和严重程度降低80%。

在该项试验中，贝勒大学心理学和神经科学教授Gary Elkins博士及其同事将184例中至重度潮热绝经后女性随机分组，分别进行催眠治疗或结构注意力控制(对照)，5次/w，持续 5 w。通过放松、直接和间接暗示、分裂或引起凉意的心理意象(如在凉爽的一天沿山间小路散步)等诱导催眠。心理意象根据患者经历进行个体化调整，重点是指导患者自我催眠，达到患者赋能的目的。

结果显示，5 w时患者潮热日记所记录的潮热频率和严重程度评分降低约70%，随访至12 w(至干预结束后7 w)的评分进一步降低至80%。另一项关键试验终点指标是通过24 h皮肤传感监测仪(生物HF记录仪)记录潮热生理测量数据，该方法特别有助于得到夜间潮热客观数据。该监测仪所记录的潮热，5 w时降低约50%，12 w时降低60%，而对照组分别下降10%和15%。此外，催眠组睡眠、抑郁和潮热相关的日常生活不适等次要终点指标也呈现明显改善。

研究者指出，如果应用得当，催眠是一种安全和有效的潮热治疗方法，睡眠改善是最大的额外收益。催眠干预效果优于其他推荐治疗方法。例如，黑升麻、大豆以及维生素E等非药物治疗与安慰剂相比几乎未见差异。虽然文拉法辛和选择性5-羟色胺再摄取抑制剂(SSRI)临床试验显示可降低潮热约50%，具有临床意义，但其作用仍小于催眠试验。此外，有些女性不愿服用药物或因副作用而不能接受药物治疗。曾经是潮热标准治疗的激素替代疗法也不再受到热捧，因为在美国妇女健康行动(WHI)研究中，16,000例受试者的乳腺癌、冠心病和卒中风险比安慰剂组分别增加26%、29%和41%，致使研究提前终止(JAMA 2004; 29:1701-12)。

催眠研究项目的下一步关键工作是尽可能广泛推广该干预技巧。在美国，潮热受累女性估计超过2,500万，其中400万属于严重潮热。研究者正致力于两种推广策略：为有兴趣的医疗专业人员设计治疗手册和为自我治疗者提供指导性催眠干预压缩光盘。

此前，在一项小规模随机试验中，研究者还发现催眠对接受激素治疗的乳腺癌存活者潮热非常有效(J. Clin. Oncol. 2008;26:5022-6)。而与此次试验不同的是，乳腺癌患者的潮热仅基于患者自我报告症状进行判断，没有生理监测数据。

该试验去年被美国行为医学学会评为补充与替代医学领域杰出研究。该试验由美国国立卫生研究院补充与替代医学研究中心资助，研究者报告无相关利益冲突。

爱思唯尔  版权所有

BY BRUCE JANCIN
Elsevier Global Medical News
Breaking News

NEW ORLEANS (EGMN) – A five-session hypnosis program reduced the frequency and severity of postmenopausal hot flashes by 80%, according to the results of a randomized controlled trial presented at the annual meeting of the Society of Behavioral Medicine.

“It appears that hypnosis, when properly applied, can be a safe and effective treatment for hot flashes. And side benefits appear likely. We had a lot of women comment that they were generally feeling better; improvement in sleep was a big deal,” Gary Elkins, Ph.D., said in presenting the results at the meeting. This trial was honored by the society as the outstanding study in the field of complementary and alternative medicine during the past year.

Dr. Elkins and his colleagues randomized 184 postmenopausal women with moderate to severe hot flashes to either five weekly hypnosis sessions or a structured attention control condition of equal duration.

Hot flash frequency and severity scores as recorded in patients’ daily hot flash diaries fell by about 70% at 5 weeks and even further to 80% at 12 weeks of follow-up, 7 weeks after the intervention ended, reported Dr. Elkins, professor of psychology and neuroscience at Baylor University in Waco, Texas.

Another key study end point was change in physiologically measured hot flashes obtained via a 24-hour skin conductance monitor sensitive to sweating; this tool was particularly helpful in getting objective data on nighttime hot flashes. Hot flashes as documented by the monitor, the Biologic HF Recorder with computer linkage, declined by about 50% at 5 weeks and 60% at 12 weeks. In contrast, the control group showed a 10% decrease in hot flashes at 5 weeks and a 15% reduction at 12 weeks.

Secondary end points assessing sleep, depression, and hot flash–related interference with daily life also showed marked improvement in the hypnosis group (see chart).

The intervention entailed hypnotic induction with relaxation and direct and indirect suggestions, dissociation, and mental imagery evoking coolness, such as walking down a mountain path on a cool day. The imagery was individualized to incorporate places a patient had been and things she’d experienced. The emphasis was on teaching patients self-hypnosis with the goal of patient empowerment, the psychologist explained.

Results with the hypnosis intervention compare favorably with studies of other proposed treatments for hot flashes. For instance, the nonpharmacologic therapies black cohosh, soy, and vitamin E have been shown “virtually indistinguishable” from placebo, according to Dr. Elkins.

Venlafaxine and selective serotonin reuptake inhibitors (SSRIs) have achieved roughly a 50% reduction in hot flashes in clinical trials. While that’s a clinically meaningful improvement, it’s a weaker effect than seen in the hypnosis trial. Moreover, Dr. Elkins noted, some women don’t want to take drugs or they experience limiting side effects. Hormone replacement therapy, formerly the standard treatment for hot flashes, has fallen into disfavor since the 16,000-subject U.S. Women’s Health Initiative was halted early due to a 26% increase in breast cancer, a 29% increase in coronary heart disease, and a 41% greater risk of stroke than in the placebo arm (JAMA 2004; 29:1701-12).

The critical next step in this hypnosis research project is to disseminate the required therapeutic skills as widely as possible. After all, it’s estimated that more than 25 million American women experience hot flashes, and 4 million of them are severely affected.

“I think we’ve shown this is a very effective therapy, but we need to find a way to make it widely available,” the researcher observed.

He and his coinvestigators are pursuing a twofold dissemination strategy. They are developing a treatment manual for interested health care professionals, although “that’s still not going to create an army of practitioners,” Dr. Elkins noted. So in addition, the investigators plan to put a guided hypnotic intervention on a compact disc for self-treatment.

“That could be very widely distributed. Even if it’s not quite as effective, I think that’s going to be the long-term way to go,” according to the psychologist.

In an earlier, smaller randomized trial, Dr. Elkins showed that hypnosis also was highly effective in reducing hot flashes in breast cancer survivors on hormone-suppressing therapy (J. Clin. Oncol. 2008;26:5022-6). Unlike the new study in women with postmenopausal hot flashes, however, the study in breast cancer patients relied solely on patient self-reported symptoms without physiologic monitoring.

The trial was funded by the U.S. National Institutes of Health’s National Center for Complementary and Alternative Medicine. Dr. Elkins and his colleagues reported having no financial conflicts.