TORONTO - Women who undergo hypnosis just before breast cancer surgery need less anesthetic and experience lower levels of pain and other side-effects following the operation, a study has found.
The U.S. study also found that patients who had a hypnosis session with a psychologist an hour before surgery spent less time in the O.R. - about 11 minutes, on average - resulting in significant cost savings, mainly due to reduced operating time.
"Breast cancer patients are a population in need," lead author Guy Montgomery, a clinical psychologist at the Mount Sinai School of Medicine, said Tuesday from New York. "They're going through a lot both from a psychological perspective as well as a physical perspective from the surgery itself."
"Our patients at discharge had less pain intensity, less pain unpleasantness, less nausea, less fatigue, less discomfort and they were less emotionally upset about the whole experience," Montgomery said of those who were hypnotized.
To conduct the study, published online Tuesday in the Journal of the National Cancer Institute, 200 women scheduled for surgical breast biopsy or lumpectomy were randomly assigned to have either a 15-minute session of hypnosis or a short period of empathetic listening with a psychologist.
Those assigned to hypnosis were first reassured about the so-called mesmerizing technique, with psychologists debunking myths about hypnosis popularized in movies and television, said Montgomery, director of the Integrative Behavioural Medicine Program at Mount Sinai.
"We answer any patient questions and the typical 'Will I cluck like a chicken?"' he said laughing. "We explain that hypnosis is not mind control, you're not going to be asked to do anything embarrassing. It's not like taking a powerful drug that leaves you zonked out."
"It's more like focused attention, focused concentration, where you're able to let yourself relax and you're the person in charge."
Each woman was asked to close her eyes and imagine herself in a special place, perhaps lying on a beach on a warm summer day. The psychologist then directed the patient to become deeply relaxed. Once hypnotized, suggestions were made specifically related to recovery from surgery.
"So we say: 'You might experience some pain after surgery, but your special place will protect you and . . . it will hardly bother you,"' Montgomery said.
"We do tell the patient this is not magic. It's not like we're going to make 100 per cent of everyone's pain go away. But rather it's a way to reduce your pain. So if your pain might have been an eight (on a scale of zero to 10), we want to get it to a four."
Researchers found that because those in the hypnotism group experienced reduced side-effects, they spent less time in hospital recovering, while less time in the operating room resulted in an average saving to a hospital of US$773 per patient.
"The most important point is this is an easy thing we can do for patients, it saves institutions money, so basically it's a win-win," he said. "We can reduce side-effects of surgery without using basically any health-care dollar resources. It pays for itself."
Dr. May Lynn Quan, a breast surgical oncologist at Sunnybrook Health Sciences Centre in Toronto, called pre-op hypnosis a "very novel idea . . . We're always looking for ways to improve the patient experience, and if we can do it without using drugs and without the purchase of an expensive piece of equipment or whatever, that's really exciting."
But Quan noted that the study relied on highly trained clinical psychologists to perform the hypnosis, a type of health provider she does not believe is abundantly available at most Canadian hospitals.
Furthermore, she said the type of anesthetic used by the U.S. doctors - a drug called propofol that produces heavy sedation rather than the unconsciousness of general anesthetic - is not widely used by breast cancer surgeons in Canada. It's unclear whether the study results would still apply.
Dr. David Spiegel, a psychiatrist at Stanford University School of Medicine in California, praised the "impressive study," saying it builds on other research that has illustrated the pain-modulating potential of hypnosis.
In an editorial accompanying the study, he said neurological research has shown that hypnosis actually alters the perception of pain, rather than merely a person's response to the pain.
"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," writes Spiegel. "It is now abundantly clear that we can retrain the brain to reduce pain: 'float rather than fight."'
Montgomery said he would like to test hypnosis on men having prostate surgery and on patients slated for other operations. He'd also like to see it become standard practice in hospitals.
"Hypnosis is easy to use. It can be administered briefly. It's a practical intervention that we can use with everything else that's going on in the surgical clinics . . . It's something in addition that has no side-effects that makes people feel better and you can do it in about 15 minutes."
