BOSTON--Use of self-hypnotic relaxation as an adjunct to sedation during invasive procedures markedly reduces the doses of analgesic and anti-anxiety medications needed, the risk of hemodynamic instability, and the duration of the procedure.[1]

The potential adverse effects of sedation are widely known: cardiovascular depression, hypoxia, apnea, unconsciousness, and sometimes death. Behavioral analgesia--in the form of imagery, relaxation training, and hypnosis--has shown efficacy in the treatment of pain during procedures. However, few studies have compared the efficacy of these adjunctive techniques with that of sedation alone. It was in response to this need that Elvira V. Lang, MD, and colleagues designed their recent study.

The researchers randomized 241 patients undergoing interventional radiologic procedures to standard care, structured attention (physicians attentively listened to their patients, responded quickly to the patients' requests, and avoided using negatively loaded questions), or self-hypnotic relaxation intraoperatively. All patients were able to control the amount of intravenous analgesia they needed and were asked to rate their level of pain and anxiety on a scale of 0 to 10 before and every 15 minutes during the procedure.

PATIENT PERCEPTIONS

The subjects' perception of pain did not increase during the procedure in the hypnosis group but increased linearly with time in the other groups. Anxiety levels decreased over time in all three groups, with the greatest reduction found in the hypnosis group.

The amount of analgesia requested was significantly higher in the standard group (1.8 units) than in the other groups (about 0.8 units). In addition, hemodynamic instability occurred less often in the hypnosis group (1% vs 15% in the standard group). This benefit cannot be explained solely by the decreased amount of analgesia used in the hypnosis group because a similar reduction was not found in the attention group (frequency of hemodynamic instability, 12%).

The duration of the procedure was significantly shorter in the hypnosis and attention groups (61 and 67 minutes) than in the standard group (78 minutes).

SELF-HYPNOSIS FOR ALL?

Dr. Lang, an associate professor of radiology and medicine at Harvard Medical School and the director of cardiovascular and interventional radiology at Beth Israel Deaconess Medical Center in Boston, believes that self-hypnosis should be an option for all types of patients. However, she admitted that the procedure may not work in psychotic patients, who are poorly hypnotizable. "Self-hypnosis is like getting absorbed in a good book while the world goes on around--but one must want to read the book," Dr. Lang recently told PULMONARY REVIEWS. "Particularly anxious patients have a lot to gain--and are best equipped to do so. A mind that can come up with a bad scenario (causing the distress) can also be guided to come up with a positive scenario," she added.

--Kristin Della Volpe

Reference
1. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet. 2000;355:1486-1490.

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