Hypnosis in a case of long-standing idiopathic itch

How practitioners (and others) can make scientifically viable contributions to clinical-outcome research using the single-case time-series design

Although clinicians typically possess considerable interest in research, especially about which interventions do and do not work, all too often they dismiss the notion that they themselves can make viable scientific contributions to the outcome literature. This derives from an unfortunate assumption that the only true experiment is a between-groups experiment. There is another form of true experiment that is perfectly compatible with real-world clinical practice: the single-case time-series design. Intensive and systematic tracking of one or a few patients over time can yield viable inferences about efficacy, effectiveness, and, under some circumstances, mechanism of change. This paper describes how clinicians working with hypnosis can carry out such research. The rationale and essential features of time-series studies are outlined; each design is illustrated with actual studies from the hypnosis literature; and new methods of statistical analysis, well within the statistical competence of practitioners, are described.

The efficacy of hypnosis in the treatment of pruritus in people with HIV/AIDS: a time-series analysis

Pruritus, or generalized itch, is a source of serious discomfort and distress in a significant minority of people living with AIDS. Anecdotal reports suggest hypnosis might be a useful treatment, leading to reductions in distress and improvements in the condition. But empirical examination of the question is notably lacking. This time-series study reports results of a 6-session self-hypnosis treatment (relaxation, deepening, imagery, and home practice) for 3 HIV-positive men suffering from pruritus, related to disease progression and/or HIV medications. Posttreatment, all 3 patients reported significant reductions in daily itch severity and extent of sleep disturbance due to itch. One patient also evidenced significantly less itch distress. Another also experienced significantly less time bothered by itch. For the 2 patients on which 4-month follow-up data were available, treatment benefit across variables was stable or further improved.

Understanding pruritus in systemic disease

Many pruritic conditions do not originate in the skin, but are the result of systemic abnormality. Among the diseases that can cause pruritus are renal insufficiency, cholestasis, Hodgkin's lymphoma, polycythemia vera, solid tumors, and many others. Other pruritic conditions appear to be iatrogenic; opioid-induced pruritus may be the most important in palliative medicine. Successful treatment of the underlying condition usually relieves itch. But, with time, many diseases progress and treatment of the cause will be impossible. Topical treatments may be of limited value. Strategies involving systemic treatments include use of antidepressants, oral opioid antagonists, or cholestyramine. There is no one cure for all pruritic symptoms. Better understanding of mechanisms of pruritus may help develop better treatments.