[Efficacy of hypnosis in the treatment of palmar hyperhidrosis with botulinum toxin type A].
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. 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. 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. 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.