BOSTON—A mind-body technique known as self-hypnotic relaxation performed during certain medical procedures significantly reduces pain, anxiety, drug use, and complications, Elvira V. Lang, MD, of Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, said in her keynote address at the Society for Integrative Oncology's Third International Conference.
Even though general anesthesia is usually not required for minimally invasive procedures, patients can still experience some level of discomfort. Most physicians rely on IV narcotics and sedatives to manage pain and anxiety. However, side effects may occur with oversedation. An approach that reduces the discomfort without relying on IV drugs is needed.
First Randomized Trial
The first randomized trial, published in The Lancet (355:1486-1490, 2000), included 241 patients undergoing procedures that involved placing catheters and/or devices such as balloons through small skin openings into the blood vessels or kidneys for diagnosis or relief of blockages. The patients were divided into three treatment groups: standard IV sedation drugs (70 patients), "structured attention or empathy" (80 patients), and "self-hypnotic relaxation or hypnosis" (82 patients). All the treatments were done during surgery, and the patients were free to request pain medicine.
In the standard-care group, the nurses attended to the patients according to hospital practices and did their best to comfort them. The care providers in the structured attention group had been previously trained to follow eight key behaviors standardized in a treatment manual, including listening atten-tively;avoiding negative suggestions (Don't say "How bad is your pain?" rather "What are you experiencing?"); providing the perception of control ("Let us know at any time what we can do for you"); swiftly responding to patients' requests; and encouraging patients by commenting on something they do well ("Thanks for lying so still because that helps us go forward with the procedure").
Patients in the hypnosis group received all of the attention received by the empathy group and in addition were read a standardized hypnotic induction script. Using this script, patients are instructed to roll their eyes upwards, close their eyes, breathe deeply, and concentrate on a sensation of floating. They are guided to imagine a safe and comfortable place and are then prompted at various times to describe how they're feeling. If they're in pain or anxious, the care provider guides them to return to a favorite, comfortable spot, or to add coolness to the pain, or to focus on another part of their body.
