Acupuncture During Surgery May Help Patients With Nosocomephobia, an Intense Fear of Hospitals, Get the Medical Care They Need
A qualitative case study performed at Hospital for Special Surgery (HSS) demonstrated that acupuncture may be an effective method for enabling patients with nosocomephobia, a type of post-traumatic stress disorder (PTSD) characterized by an intense fear of hospitals and medical settings, to feel reassured enough that they are able to get the medical care they need. These findings were presented at the 6th World Congress on Regional Anaesthesia & Pain Medicine in Paris, France, September 2023.1
“The feeling of fear is very natural, and every single one of us knows that feeling,” said Stephanie Cheng, MD, DABMA, FAAMA. Dr. Cheng is an anesthesiologist at HSS and developed HSS’s protocols for using acupuncture in the operating room. “For some people, that fear can become irrational and develop into PTSD. Although exact numbers are unknown, reported estimates for the incidence of PTSD in the United States are approximately 6%, with women having twice the rate of men.
“For patients with nosocomephobia, it can make getting care in the hospital setting very hard,” she continues. “We don’t even know how many of these ‘unseen patients’ are out there because they just don’t come to the hospital.”
Current treatments for nosocomephobia include techniques such as cognitive behavioral therapy, exposure therapy, hypnotherapy, and medications.
“It’s worth noting that acupuncture isn’t even listed as a treatment on many patient information websites, despite it being well researched in PTSD patient populations,” Dr. Cheng said. “While acupuncture has been well studied with outpatient PTSD patients, specifically in the military, using it in the operating room is almost unheard of. Our study shows that offering acupuncture to patients is something that can help them feel more in control of the situation and get through surgery successfully.”
For these case studies, two patients were interviewed about their nosocomephobia and their prior hospital experiences. Using Dedoose software, six reviewers coded the interview transcripts line-by-line. The reviewers labeled meaningful words, phrases, and sentences, and created more than 600 codes. The reviewers grouped similar codes to identify themes, and then conducted a thematic analysis to generalize the study’s themes and construct its theoretical framework.
This analysis demonstrated how nosocomephobia affected patients’ perceptions of surgery and helped identify their individual fears. The researchers diagrammed the thought process of the patients to show how they considered whether they felt comfortable enough to get surgery. The appraisal process included three steps: experiencing the stressor (surgery), how they would be able to cope (acupuncture), and their mental state about whether they believed they could go through with the surgery (reappraisal).
In the case of these two patients with nosocomephopbia, acupuncture was a safe, non-invasive way for them to manage their preoperative anxiety and undergo elective surgery.
“Our research is based on a limited number of cases and makes it difficult to draw any major conclusions. We need to study more patients who have a major fear of hospitals and who need surgery and see whether offering acupuncture intraoperatively can successfully get those patients through surgery,” Dr. Cheng explained. “We also need to make more patients and doctors aware that this modality is available, and that it can be really helpful to patients suffering with PTSD.”
“If the addition of intraoperative acupuncture can prove to be helpful for patients who have a fear of hospitals, then we can really change the quality of life of a segment of the population that has historically been difficult to treat. The unseen patient can finally be seen,” Dr. Cheng concluded.
1. Pa Thor PhD, Andrew Moreno MS, MD, Haoyan Zhong MS, Miriam Sheetz BS, Marko Popovic BS, Sabrina M. Strickland MD, Michael P. Ast MD, Stephanie I. Cheng MD, DABMA, FAAMA. “A Qualitative Analysis of Intraoperative Acupuncture for Nosocomephobia: The Unseen Patient.” Presented at: 6th World Congress on Regional Anaesthesia & Pain Medicine, September 6-9, 2023, Paris, France.
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.