Hypnosis reduces pain and
shortens select surgical procedures
BY MIKE GOODKIND
In the first large
research study of its type, patients who received
hypnosis during minimally invasive surgery not only
reported less pain and anxiety but also suffered fewer
complications than patients who received standard
treatment for pain during the procedures.
Patients who received
hypnosis on average spent significantly less time in the
procedure room than other similar patients also
undergoing one of several minimally invasive, medical
procedures for blood vessel or kidney disease --
presumably because the hypnosis patients' greater comfort
allowed their doctors to complete procedures more quickly
and efficiently, said David Spiegel, MD, professor of
psychiatry and behavioral sciences at the School of
Medicine and medical director of the Complementary
Medicine Clinic at the Medical Center. Spiegel was senior
author with colleagues from Harvard and Beth Israel
Deaconess Medical Center, Boston, on the study published
April 29 in the British medical journal Lancet.
"We're not surprised,
but this study is important as further evidence that
'mind over matter' is not just a cliché, and hypnosis
provides a number of measurable benefits," said
Spiegel.
The 241 patients at Beth
Israel were divided into three groups: 79 patients
received standard care, including typical verbal
encouragement from nurses and doctors; 80 patients
received "coaching," one-on-one verbal support
from a staff member; and 82 patients were taught to use
hypnosis, involving traditional techniques designed to
refocus attention and produce muscle relaxation. A nurse,
two medical students and a psychology graduate students
were trained in hypnosis to test the hypothesis that
ordinary health workers could be trained to administer
hypnosis in a medical setting.
All patients were offered
standard pain-control medication (patient-controlled
analgesia through an intravenous line) and were awake and
alert, as is customary during these procedures. The group
that received neither hypnosis nor one-on-one coaching
requested and
received the largest amount of pain medicine, while
patients receiving "coaching" also used more
painkillers than the hypnosis group.
Spiegel said reduced use
of analgesia might have contributed to a lower rate of
medical complications among the hypnosis patients. Only
one hypnosis patient's blood pressure became unstable,
compared with 10 "coaching" patients and 12
standard care patients.
Procedure time was 61
minutes for the hypnosis group, 17 minutes shorter than
for the standard group and six minutes shorter than for
the "coaching" group, the authors noted.
The shorter time may have
contributed to patients in the hypnosis group reporting
less pain, since the intensity of pain appeared to
increase with the length of the procedure, Spiegel
explained.
The procedures studied
involved the use of specially designed, miniaturized
instruments that are threaded into blood vessels along
with tiny video cameras to allow physicians to view the
procedure. Known as percutaneous transcatheter diagnostic
and therapeutic peripheral vascular and renal
interventions, these procedures were selected for the
study because they are normally performed without the
need for a general anesthetic while the patient is awake
and alert and able to respond to self-help techniques,
Spiegel said.
Spiegel and Stanford
colleagues have also completed a study that used PET
(positron emission tomography) brain scans to document
that hypnosis changes brain activity related to visual
color perception, analogous to clinical changes related
to pain perception, and they will publish their findings
soon, he said.
Lead author of the Lancet
study was Elvira V. Lang, MD, Beth Israel Deaconess
Medical Center/Harvard Medical School, formerly a faculty
member at Stanford. The study was supported by grants
from the National Institute of Mental Health and the
National Center for Complementary and Alternative
Medicine. SR
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