Hypnosis in Surgery

Hypnosis has a long history of involvement with surgery. At around the time the first anaesthetics were being discovered hypnosis was beginning to be used by a number of surgeons to perform supposedly pain-free operations: in the early nineteenth century James Braid, John Elliotson and James Esdaile were all reported to have successfully used hypnosis on surgical patients. With the development of ether and other anesthestics, which worked reliably with large numbers of patients, hypnosis was sidelined. However, there has recently been a resurgence of interest in using hypnosis alongside modern anesthetics and the benefits look considerable.

In 2000 Elvira Lang and colleagues published a randomised controlled trial in The Lancet on 241 patients undergoing invasive surgery to the arteries, veins, or kidneys. They compared three treatments: self-hypnotic relaxation, attention control, and standard care. Approximately 80 patients were randomised to each of these groups. The surgery was conducted under conscious sedation - patients were given
Midazolam which leaves them awake but sedated. The standard treatment group consisted of treatment as usual. The attention control condition included an additional member of the surgical team paying special attention to the patients needs, providing the feeling of control and swift response to the patient's requests. The hypnotic condition involved an additional member of the surgical team acting as in the attentional control condition, but additionally administering a rapid hypnotic induction, giving suggestions for a sensation of floating, and encouraging the patient to use self-generated imagery. When the results were assessed it was found that patients in the attention and standard treatment group reported that their pain got steadily worse as the operation went on, but that patients in the hypnosis group continued to remain relatively pain free over the same period. Patients in the hypnosis and attention groups requested and received approximately half the amount of pain medication than patients in the standard care group.

In 2007 Guy Montgomery and colleages published the results of their latest study in the Journal of the National Cancer Institute. Theirs was a randomized controlled trial in a group of 200 women undergoing breast surgery. Patients were randomly assigned to a hypnosis group, or an empathic listening group. The hypnosis group received a 15 minute psychologist-conducted hypnosis session in the hour before the surgery, and the empathic listening group received a 15 minute nondirected listening session with a psychologist before the surgery. Patients in the hypnosis group experienced significantly less pain, nausea, fatigue, discomfort and emotional upset. Of six drugs (painkillers and sedatives) given to the patients during and after the operation, patients in the hypnosis group needed significantly less of two of them, and equal amounts of the others. The authors measured the amount of time patients spent in the operating room, and drug costs, and determined that total costs for patients in the hypnosis group were $3146.90, versus $3919.51 per patient in the attention group. These figures demonstrate the cost-effectiveness of a brief pre-surgical hypnosis intervention.

The results of these two studies indicate that hypnosis can safely and cost-effectively be integrated as part of standard surgical procedure for some operations. There are significant benefits to patients in terms of reduced pain and discomfort, and there may be significant benefits to health care providers in terms of overall cost.