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Stanford Report, May 31, 2000

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