Change Your Life: Living Skillfully

I recently came across a 2007 study: A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients (Guy H. Montgomery, Dana H. Bovbjerg, Julie B. Schnur, Daniel David, Alisan Goldfarb, Christina R. Weltz, Clyde Schechter, Joshua Graff-Zivin, Kristin Tatrow, Donald D. Price, Jeffrey H. Silverstein, Journal of the National Cancer Institute 2007 99(17):1304-1312; doi:10.1093/jnci/djm106). That link is to the full study. Kudos to the JNCI for making it freely available on the open Internet!

This is an excellent study for a number of reasons. The intervention was simple and brief (15 minutes of hypnosis presurgery). There was a comparable control condition (15 minutes of empathic listening from the same people who administered the hypnosis), and while the authors stop short of claiming that the people assessing the effects couldn’t know whether the participants were in the experimental or control group, it sounds like they were unlikely to, which would make it a single-blind study. It had a large group of participants (200 people), who were randomly assigned to the experimental or control condition in a way which matched other characteristics of the patients between the two conditions. It showed good, clear, strong effects on a number of important outcome measures: use of particular anaesthetic drugs, reported pain intensity, pain unpleasantness, nausea, fatigue, discomfort, emotional unpleasantness and time in surgery. And there is a cost-benefit assessment included in the study: on average, surgery for the hypnotherapy patients cost 9% less than for the control group (a saving of over $770 for a 15-minute intervention), largely because of reduced surgery time.

photo credit: salimfadhley

I have direct experience of the effect of hypnosis with a surgical patient – my wife, who had to have an ankle operation last year. Because of an administrative error her surgery was delayed, giving me plenty of time to work with her on relaxation and pain reduction. For technical reasons she had to remain conscious, with a spinal epidural instead of general anaesthetic. She is not a particularly calm person (she’s from California), and she’s had bad experiences with surgery before. The epidural was an unknown for her and a potential source of anxiety. She’s not even a particularly good hypnotic subject, but she reported that in contrast to previous surgeries she was very calm and the process went well with minimal pain.

Based on the research, this isn’t atypical. One of the studies cited by this study, with some of the same authors including the lead author, is a meta-analysis which compares 20 different studies on the use of hypnotherapy in surgery: The Effectiveness of Adjunctive Hypnosis with Surgical Patients: A Meta-Analysis
(Guy H. Montgomery, Daniel David, Gary Winkel, Jeffrey H. Silverstein, and Dana H. Bovbjerg, Anesthesia and Analgesia 2002;94:1639-1645 – also full text available openly online). According to that analysis, “patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients.” The effect sizes were “medium to large” – this isn’t just a slight improvement that’s only visible to close statistical analysis over a large group.

photo credit: jurek d.

If this was some biochemical, or even procedural, intervention rather than that ooky-spooky mind stuff, people would practically be getting fired for not using it. After all, this is being published in a peer-reviewed journal, published by a society that has 15,000 members worldwide. Writing in the same journal in 2007 (and somewhat cautiously citing the meta-analysis), an anaesthesiologist teaching at the University of Florida College of Medicine states:

…more than 150 yr have passed since the first documented use of hypnosis as the sole anesthetic for general surgical cases. We now have data showing physically measurable effects of suggestion or hypnosis on the nervous system. Imaging and electrophysiologic studies have demonstrated changes in spinal and supraspinal pain pathways under the influence of hypnosis. Because suggestions and focused attention can measurably alter pain perception and pain pathways, a similar influence may be expected for the autonomous nervous system involved in modulating gastric motility, regional blood perfusion, and the humoral response to stress. Faster wound healing, earlier postoperative gastrointestinal recovery, and less nausea have been reported when hypnosis or positive suggestions were part of the perioperative management…. What other therapeutic measure appears so devoid of increased cost and demonstrable adverse effects? Personal attention to the patient, emotional support, positive suggestions, and even hypnosis are readily available, safe, inexpensive, and attractive measures that might improve the care of our patients.

- Hypnosis and Surgery: Past, Present, and Future (Albrecht H. K. Wobst, Anesthesia and Analgesia 2007;104:1199-1208, doi: 10.1213/01.ane.0000260616.49050.6d).

So, three messages.

If you are going to be having surgery, look into getting hypnotherapy from a qualified practitioner. If you can’t get it live, recordings are also effective. The evidence is that you are very likely to benefit from reduced pain and suffering and possibly better outcomes also.

If you are a surgeon or anaesthetist, take a look at the evidence and consider learning hypnosis, getting a member of your team to learn it, or working with someone who already knows it. The intervention described in the clinical trial for cancer patients is not a complex one, and any competently trained hypnotist could administer it or one like it easily and effectively.

And if you are a hypnotherapist, make this research known as widely as possible! I am planning to approach the NZ Hypnotherapy Federation to put together a Health Working Group, both to publicize this kind of research and also to look at running some research-based training for specific health interventions. If you’d like to be involved (whether you’re located in NZ or not), please contact me through the comments or through email – mikerm at hypno dot co dot nz.

Relevant Product: Pain Management (audio CD)

Technorati Tags: surgery, pain, anesthesia, analgesia, hypnosis, hypnotherapy, research, clinical trial, randomized, controlled, cost savings

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