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Hypnosis Reduced Pain, After Effects And Cost Of Breast Cancer Surgery

A new US study showed that using hypnosis before breast cancer surgery led to patients reporting less pain and fewer unpleasant after effects and it saved hospital costs. Procedures took less time and the amount of anesthetic required was also reduced, said the authors of the study.

The study is published in the 28th August online issue of the Journal of the National Cancer Institute and is the work of scientists at the Mount Sinai School of Medicine, New York, and colleagues.

Patients undergoing surgery for breast cancer often have unpleasant side effects including nausea and fatigue both during and after the procedure. This results in longer hospital stays, can sometimes lead to readmission, or extra medication, with a corresponding increase in cost.

Other studies have suggested hypnosis may reduce pain, recovery time and post operative medication.

Co-author of the study, Dr Guy Montgomery of the Mount Sinai School of Medicine, and colleagues carried out a clinical trial to find out the effects of hypnosis when given one hour or less before the operation.

200 female breast cancer surgery patients were randomly assigned to one of two groups: the hypnosis group and the control group.

The patients in the hypnosis group had 15 minutes of hypnosis administered by a psychologist. This was long enough for the psychologist to suggest how best to relax and imagine pleasant visual imagery, and the patients were also taught some pain reduction techniques, how to reduce nausea and fatigue and how to administer basic self hypnosis.

The patients in the control group just had a chat with a psychologist.

Montgomery and colleagues compared the results of the two groups. They analyzed use of pain medication, use of sedatives during surgery, and the reported levels of pain and side effects after surgery.

They found that compared to the control group, patients in the hypnosis group:

• Needed less anesthesia during surgery.

• Reported less pain, discomfort, nausea, fatigue, and emotional upset after the surgery.

• Spent less time in surgery (almost 11 minutes less).

• Had lower surgical costs (reduction was about 773 dollars per patient).

• The cost reduction was mainly due to time saving of surgery.

The authors wrote that:

"Together, the combination of potential improvements in symptom burden for the hundreds of thousands of women facing breast cancer surgery each year and the economic benefit for institutions argues persuasively for the more widespread application of brief presurgical hypnosis."

A drawback of the study was that patients were not blinded to their assigned groups and there was no formal assessment of the pros and cons of blinding on the treatment administrators. This would be normal procedure in a more rigorous blinded controlled trial.

The authors also said that they don't know whether the hypnosis would have been as effective if it had not been administered by non-psychologists.

The study concluded that:

"Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients."

The history of hypnosis in medicine and the scientific evidence on the pain reducing effects of the treatment are described in an accompanying editorial by Dr David Spiegel of Stanford University School of Medicine in Palo Alto, California. Spiegel said:

"It has taken us a century and a half to rediscover the fact that the mind has something to do with pain and can be a powerful tool in controlling it."

"It is now abundantly clear that we can retrain the brain to reduce pain: "float rather than fight", he added.

"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.
J Natl Cancer Inst 2007; 99:1304-1312.
Published online 28 Aug 2007.
doi:10.1093/jnci/djm106

Written by: Catharine Paddock

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