The power of the nocebo effect: when hypnosis fails in tooth surgery

The power of the nocebo effect: when hypnosis fails in tooth surgery

This study is about a particularly fascinating case in dentistry, in which a patient who was considered to be very hypnotic should be subjected to dental operation - more precisely the removal of a wisdom tooth. Instead of using traditional anesthesia methods, the Medical team relied on hypnosis as the sole narcotic method. The patient had previously had positive experiences with hypnosis in dental interventions.

Surprisingly, hypnosis did not seem to work at first. The cause of the problem was a negative expectation of the patient, triggered by the skeptical opinion of another dentist regarding the effectiveness of hypnosis as an anesthetic method. This led to an increased activity of the sympathetic nervous system - recognizable by increased heartbeat, increased electrical painter activity and reduced variability of the heart rhythm - which indicates an increased stress reaction.

After a deepening of hypnosis, however, it was possible to achieve full hypnotic analgesia. The successful implementation of the operation was associated with a reduction in the aforementioned stressful climbers and an increase in cardiac rate variability, which indicates an increased activity of the parasympathetic nervous system. This case illustrates how strongly the psyche and expectations of the patient can influence the physical reaction to pain treatments.

The implications of this research are far -reaching. On the practical level, it shows that hypnosis can be an effective method of narcotics, provided that the patient has a positive attitude and is prepared accordingly. In addition, it emphasizes the importance of communication in the medical field: negative opinions and expectations can literally affect the success of treatment. In the future, this case could lead to hypnosis as an alternative or complementary narcotic method in dentistry is more serious and the training in the field of patient communication is intensified.

basic terms and concepts

• anesthesia: Medical measure to temporarily switch off the pain sensation during medical interventions.
• hypnosis: A condition of changed attention and increased suggestibility, in which the individual's consciousness is modified so that it can react to suggestions.
• nocebo effect: A negative effect on health that occurs because the patient expects treatment or medication.
• sympathetic nervous system: part of the autonomous nervous system that prepares the body for activity in stressful situations ("fighting or flight" reaction).
• parasympathetic nervous system: part of the autonomous nervous system, which is responsible for calm and relaxation of the body.
• Heart rate variability: The variation in the time intervals between heartbeats. An indicator of the activity of the autonomous nervous system.
• Electrodermal activity: Changes in the electrical resistance of the skin due to the production of sweat that is associated with emotional conditions.

Successful overcoming of a nocebo reaction by deepening hypnosis in dentistry

The study presented examines a remarkable case in which a patient with high hypnotizability underwent a distance of the third molar, in which hypnosis was used as the sole anesthesia method. The patient had successfully completed similar interventions under hypnosis in the past, but in this case an unexpected nocebo reaction initially entered that was due to negative preliminary information by a previous dentist.

This nocebo reaction manifested itself through two sympathizers of the patient and the associated increase in sympathetic activity, can be obtained to increased heart rate and electrical painting activity as well as reduced heart rate variability. A deepening of hypnosis finally led to a complete hypnotic analgesia and made it possible to successfully complete the intervention. This change correlated with a decrease in the cardiac rate and electroder painter activity and an increase in cardiac rate variability, which indicates a reversal of the balance of likeable and parasympathetic activity.

The patient's postoperative self-disclosure confirmed that the initial failure of hypnosis was due to a strong nocebo effect caused by the skeptical attitude and negative communication of a former dentist about the effectiveness of hypnosis as an anesthesia method when removing the third molar.

The results of this case illustrate the significant potential of hypnosis in dental anesthesia and emphasize the importance of communication between the dentist and patient in the context of expectation management and avoiding nocebo reactions through negative preliminary information. They also underline the relevance of physiological measurements to record the effectiveness and the success of hypnotic interventions.

The complete research article with detailed methods, results and discussions is accessible at https://pubmed.ncbi.nlm.nih.gov/38363817 .