Hypnosis for invasive medical procedures: a randomised trial

A Prospective, randomized trial described in The Lancet, Volume 355, Issue 9214, Pages 1486 – 1490, 29 April 2000, evaluated the effectiveness of hypnosis – termed “nonpharmacologic analgesia” – in easing pain and anxiety associated with undergoing minimally invasive surgical procedures such as angiograms and angioplasties (which require catheterization of arteries), nephrostomies (kidney drainage), and liver biopsies.

The researchers randomly assigned 241 patients treated in a radiology unity at a university hospital to one of three groups: standard treatment, structured attention, and hypnosis (or self-hypnotic relaxation). The standard treatment group received care typical for the hospital, i.e., nurses did their best to comfort patients. In both the structured attention and hypnosis groups, a specially trained member of the procedure room team attentively responded to patient comments and concerns, carefully avoiding statements or questions that could upset the patient (e.g., “How bad is your pain?” or “you’ll feel a sting and burn now”). The hypnosis group also listened to a script during the procedure that instructed them to roll their eyes upwards and close them, breathe deeply, and concentrate on the sensation of floating. They then were talked through a process of focused imagery directing their attention away from pain and anxiety and toward a “safe and comfortable” place. All interactions were videotaped to make sure protocol was followed. Patients rated their pain and anxiety before surgery and every 15 minutes during it, according to a standardized pain scale. They were given a button to alert the attending nurse whenever they wanted medication for pain or anxiety. In only a few cases did medical personnel override patient drug requests, such as when blood pressure fell below or exceeded desirable levels.

The researchers – Elvira Lang, M.D., Director of Interventional Radiology at Beth Israel Deaconess Hospital, Boston, and colleagues – found several indications that hypnosis was more effective and safer than either of the controls. Procedures in the hypnosis group needed less time to complete than those in the attention group, and even less time than those in the standard group. Patients in the hypnosis group used less than half the amount of drugs as the standard treatment group and about the same as the attention group. After an hour of procedure time, pain and anxiety were lowest in the hypnosis group, in between in the attention group, and highest in the standard group, regardless of the amount of drugs given. And finally, in a surprising finding, only the hypnosis group remained “hemodynamically stable,” meaning blood pressure and heart rate did not increase or decrease to levels that caused concern or required extra attention in the procedure room.

According to a separate analysis of the data, using hypnosis reduced the cost of I.V. sedation in the procedure room by $130 per patient. In addition, hypnosis cut procedure room time by 17 minutes, even though the self hypnotic relaxation technique itself required 10 minutes to administer. In addition, hypnosis had a long-lasting effect on pain and anxiety; study researchers observed that even four hours after the start of the procedure, hypnotized patients were doing much better. And the longer the procedure lasted, the greater the difference was between the standard care and hypnosis groups.

This study did verify that hypnosis might be used for procedures that cause pain and anxiety such as angioplasties, colonoscopies, and MRI. Self-hypnotic relaxation brings a safe and cost-saving protocol to the hospital procedure regimen.

By Anne H. Spencer, Ph.D.

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