Hypnotic induction and therapeutic suggestions in first-trimester pregnancy termination

The effectiveness of suggestive techniques in reducing postoperative side effects: a meta-analysis of randomized controlled trials

BACKGROUND

Suggestive interventions such as hypnosis and therapeutic suggestions are frequently used to alleviate surgical side effects; however, the effectiveness of therapeutic suggestion intervention has not yet been systematically evaluated. In the present study, we tested the hypotheses that (1) suggestive interventions are useful for reducing postoperative side effects; (2) therapeutic suggestions are comparable in effectiveness to hypnosis; (3) live presentation is more effective than recordings; and (4) suggestive interventions would be equally effective used in minor and major surgeries.

METHODS

We performed random effect meta-analysis with meta-regression and sensitivity analysis by moderating factors on a pool of 26 studies meeting the inclusion criteria (N = 1890). Outcome variables were postoperative anxiety, pain intensity, pain medication requirement, and nausea.

RESULTS

Suggestive interventions reduced postoperative anxiety (g = 0.40; 99% confidence interval [CI] = 0.13-0.66; P < 0.001) and pain intensity (g = 0.25; 99% CI = 0.00-0.50; P = 0.010), but did not significantly affect postoperative analgesic drug consumption (g = 0.16; 99% CI = -0.16 to 0.47; P = 0.202) and nausea (g = 0.38; 99% CI = -0.06 to 0.81; P = 0.026). No significant differences were found for intervention type, presentation method, and severity of surgery; however, sensitivity analysis only supported the effectiveness of hypnosis (g = 0.62; 99% CI = 0.31-0.92; P < 0.001) and live presentation (g = 0.55; 99% CI = 0.23-0.88; P < 0.001) for decreasing postoperative anxiety, and that of live presentation for alleviating postoperative pain (g = 0.44; 99% CI = 0.07-0.82; P = 0.002). Sensitivity analyses also suggested that suggestive interventions are only effective for decreasing pain intensity during minor surgical procedures (g = 0.39; 99% CI = 0.00-0.78; P = 0.009).

CONCLUSIONS

Suggestive techniques might be useful tools to alleviate postoperative anxiety and pain; however, strength of the evidence is weak because of possible bias in the reviewed articles. The lack of access to within-subjects data and the overlap between moderator conditions also limit the scope of the analysis. More methodologically correct studies are required with sensitivity to moderating factors and to within-subjects changes. For clinical purposes, we advise the use of hypnosis with live presentation to reduce postoperative anxiety and pain, until convincing evidence is uncovered for the effectiveness of therapeutic suggestions and recorded presentation. Pain management with adjunct suggestive interventions is mostly encouraged in minor rather than major surgeries.

The effectiveness of hypnosis in reducing pain and suffering among women with metastatic breast cancer and among women with temporomandibular disorder

The authors describe two studies of special interest to clinicians and clinical researchers. Both are randomized controlled studies, exclusively focused on female patients. The first study tests whether a year-long weekly group intervention including hypnosis can reduce cancer pain among women with metastatic breast cancer. Findings suggest the intervention slowed the increase in reported pain over a 12-month period relative to controls. The second study examines the effect of hypnosis in women suffering from temporomandibular disorder (TMD), with a special focus on function as well as pain. Hypnosis reduced TMD pain as measured by a numerical-rating scale.

Hypnotizability and opinions about hypnosis in a clinical trial for the hypnotic control of pain and anxiety during pregnancy termination

This descriptive study evaluates the hypnoanalgesic experience's effect on participants' hypnotizability and opinions about hypnosis and identifies factors associated with hypnotizability. Hypnotizability was assessed using the Stanford Hypnotic Susceptibility Scale: Form A in 290 women 1 month after their participation in a randomized clinical trial evaluating hypnotic intervention for pain/anxiety versus standard care during pregnancy termination. Opinions were collected before and after the intervention. The regression model describing hypnotizability (F = 13.55; p < .0001; R(2) = 0.20) retained 5 variables but not the intervention group. The variable explaining most of total variance (62.9%) was the level of perceived automaticity/involuntariness. Opinions about hypnosis were modified by the hypnotic experience compared to standard care but were not associated with hypnotizability. Exposure to hypnoanalgesia did not influence hypnotizability but modifies significantly the opinions about hypnosis. Consistent with previous findings, perceived automaticity appears to best predict hypnotizability.

Clinical research on the utility of hypnosis in the prevention, diagnosis, and treatment of medical and psychiatric disorders

The authors summarize 4 articles of special interest to the hypnosis community in the general scientific and medical literatures. All are empirical studies testing the clinical utility of hypnosis, and together address the role of hypnosis in prevention, diagnosis, and treatment of medical and psychiatric disorders/conditions. The first is a randomized controlled study of smoking cessation treatments comparing a hypnosis-based protocol to an established behavioral counseling protocol. Hypnosis quit rates are superior to those of the accepted behavioral counseling protocol. A second study with pediatric patients finds hypnosis critically helpful in differentiating nonepileptic seizure-like behaviors (pseudoseizures) from epilepsy. The remaining 2 papers are randomized controlled trials testing whether hypnosis is effective in helping patients manage the emotional distress of medical procedures associated with cancer treatment. Among female survivors of breast cancer, hypnosis reduces perceived hot flashes and associated emotional and sleep disruptions. Among pediatric cancer patients, a brief hypnotic intervention helps control venepuncture-related pain.

Hypnotic analgesia intervention during first-trimester pregnancy termination: an open randomized trial

OBJECTIVE

The purpose of this study was to determine whether hypnotic analgesia can reduce the need for intravenous sedation analgesia without increasing pain and anxiety levels during abortion.

STUDY DESIGN

A cohort of 350 women who were scheduled for surgical abortion (< 14 weeks' gestation) were assigned randomly to a standard care group or a group that received a standardized hypnotic analgesia intervention 20 minutes before and throughout the surgical procedure. Primary outcome was the difference between the 2 groups: (1) the proportion who received sedation (yes/no) during the surgical procedure and (2) self-assessments of pain and anxiety during suction evacuation of uterus content.

RESULTS

Women who underwent hypnosis required less intravenous sedation analgesia (108/172 women; 63%) than the control group (149/175 women; 85%; P < .0001) and self-reported no difference in pain, but not in anxiety, levels during suction evacuation.

CONCLUSION

Hypnotic interventions can be effective as an adjunct to pharmacologic management of acute pain during abortion.