Hypnosis For Pain Control
Univ. of Washington Medical Center
Source: The Lancet, April 29, 2000 v355 i9214 p1486.
Title: Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomized trial.(Statistical Data Included)
Author: Elvira V Lang, Eric G Benotsch, Lauri J Fick, Susan Lutgendorf,
Michael L Berbaum, Kevin S Berbaum, Henrietta Logan and David Spiegel
Abstract: The use of behavioral methods in addition to drugs during surgical procedures seems to be effective and safe. Hypnosis had the most significant effects in relieving pain and reducing anxiety. A total of 241 patients were divided into three groups. During vascular or kidney surgery, they received standard care (79), structured attention (80), or self-hypnotic relaxation (82), and had intravenous control of analgesics. They rated pain and anxiety every 15 minutes. Pain increased in the standard and attention groups but remained flat with hypnosis. Anxiety decreased in all three groups over time, and the standard care group used more analgesics.
Subjects: Hypnotism in surgery – Therapeutic use Analgesics – Usage
Background Non-pharmacological behavioral adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing per-cutaneous vascular and renal procedures in a prospective, randomised, single-centre study.
Methods 241 patients were randomized to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures.
Findings Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p [less than] 0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of 20.04 (standard), 20.07 (attention), and 20.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min).
Interpretation Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
Lancet 2000; 355: 1486-90
Minimally invasive, image-guided, per-cutaneous medical procedures increasingly replace open surgery. Technical refinement minimizes tissue injury and largely obviates the need for general anesthesia, but patients may still experience distress, which can tax the coping mechanisms of even well-functioning individuals.(1) Most physicians rely on intravenous conscious sedation with narcotics and sedatives to manage pain and anxiety.(2) These drugs, however, can induce cardiovascular depression, hypoxia, apnoea, unconsciousness, and, rarely, death, even in dosages usually well tolerated.(3,4) The operator typically has to weigh the risks of medically induced over-sedation against the risks of uncontrolled discomfort and restlessness. An approach that provides comfort while reducing or eliminating the need for intravenous drugs is, therefore, highly desirable.
Biobehavioural “non-pharmacological” analgesia in the form of imagery, relaxation training, and hypnosis has been used successfully to treat procedure pain.(5-10) Clinical practice guidelines for acute pain management, published by the US Public Health Service, mention relaxation exercises and cognitive approaches, but do not elaborate.(2) Behavioral methods still need testing in larger clinical studies. To address this need, we designed a prospective randomized trial comparing the standard approach of intravenous conscious sedation alone with the adjunctive use of two behavioral non-pharmacological interventions: structured attention and self-hypnotic relaxation. We tested the hypothesis that adjunctive non pharmacological analgesia would reduce patients’ perceived pain and anxiety during interventional radio-logical procedures, reduce the amount of intravenous conscious sedation needed and make the procedure safer. Since operating teams (and hospital administrators) are very sensitive to factors that could prolong the patient’s stay in the procedure room, we also assessed how non-pharmacological analgesia adjuncts affect procedure time.