Hypnotherapy may be an effective way to reduce opioid use in post-surgical settings, according to new research.
In a study of submitted patients total knee arthroplasty (TKA), people undergoing hypnosis before surgery used fewer postoperative opioids than their non-psychotic counterparts, although pain, length of hospital stay, and complications were similar between the two groups of patients.
The results of the randomized controlled study showed that patients receiving hypnosis experienced a 24% reduction in postoption opioid use compared to the group that did not have hypnosis.
“I hope this intervention will draw the attention of surgeons and internists and anesthesiologists, as it is a viable option for surgical patients. [to reduce opioid use]”said study researcher Jessie Kittle, MD, Stanford School of Medicine, Stanford, California Medscape Medical News.
The results were presented at the 2021 annual meeting of the American American Academy of Pain Medicine (AAPM) virtual.
An underused therapy?
“I chose a job outside my residence as a surgical pain treatment hospitalist and would see a lot of people coming in for orthopedic surgery, and it occurred to me that a good 50% of my day would treat opioid-related complications afterwards. of surgery “. said Kittle.
“I was getting inquiries for low blood pressure, vomiting, constipation this became intestinal obstructions and yet people also had horrible pain all the time. I thought there had to be other tools that we could use besides opioids, ”Kittle said.
He began to delve into the literature on pain treatment after orthopedic surgery and was surprised to find a wealth of literature on the use of hypnosis for procedural pain and the reduction of opioid use.
“I couldn’t believe I hadn’t heard of this before in medical school or otherwise,” he said.
Not everyone is hypnotizable, Kittle said. About 75% of the population can be hypnotized and this ability remains stable for each person throughout their life.
“We can test it with functional MRI. If we put people who are not hypnotizable in a state of memory, hypnosis and rest, where they don’t think about anything, nothing happens. But when you try to hypnotize people who are highly hypnotizable , you see a huge change in the connections between certain parts of the brain, “he explained.
While not everyone is hypnotizable, there could be added benefits of a placebo effect.
“If you take a very motivated person and you want hypnosis to work and they really trust the doctor and they think that good result will come, they may get a benefit, but yes, there will be some people for whom this will not work,” said Kittle.
The study was conducted at Stanford from October 2017 to December 2019 and included 64 patients undergoing TKA who were randomized to receive hypnosis (n = 31; mean age 71 years; 65% women) or no hypnosis (controls, n = 33; mean age, 66 years; 51% female).
Randomized patients in the hypnosis group received a 10-minute hypnosis session between 1 week and 1 day before surgery. They also had access to a recording of the session.
“The recording was basically the hypnosis session they had with me. They could call the phone number and listen to it at any time, and in the end they could leave me their name and date of birth. That’s how I went. keep track of how often they listened to the recording, ”Kittle explained.
“The script covers body relaxation and includes a direct visualization of the location of the pain in the body, its appearance and its sensation, to imagine what it would be like if it were a shape and then imagine its shape changing its characteristics to make. the most comfortable and finally ask him to move completely from the body.
“We also talk about how natural it is to feel nervous before surgery [and] to give them positive reinforcement about all the normal feelings people have about surgery and, after surgery, imagine enjoying their best physical function and recovery, ”he said.
The results showed a 24% reduction in postoperative opioid use in the hypnosis group compared to the non-hypnosis group. The mean consumption of postoperative opioids (ED) was 2.9 (2.0) orally morphine milligram-hour equivalents (MME / h) in the hypnosis group and 3.8 (3.1) in the control group (Pg = .2007).
In addition, of the study patients who had opioids before surgery, those in the hypnosis group (n = 9) reduced postoperative opioid use by 55% compared with those in the control group (n = 8). ). The mean postoperative opioid (ED) use was 3.4 (2.3) MME / h in the hypnosis group and 7.5 (3.1) MME / h in the control group (Pg = .0082).
Patient satisfaction with hypnosis was high, with 72% of participants in this group reporting pain relief and 93% reporting that they would use it again.
Commenting on the findings of Medscape Medical News, Ann E. Hansen, DVM, MD, associate chief of staff in primary care, VA Texas Valley Coastal Bend Health Care System, Harlingen, Texas, said she agrees that medical education should include hypnotherapy.
“Primary care providers and hospitalists should be familiar with validated hypnotic susceptibility scales and the simple Spiegel eye roll test, which tests hypnotization,” said Hansen, who did not participate in the study. .
“It ‘s a new field [and] there is not enough data yet. Hypnosis is not general, so any contribution to raising awareness is good, as it is potentially a very effective modality, ”he said.
Hansen is an advocate of the Spiegel eye roll test, discovered by Dr. Herbert Spiegel in 1972.
“People dyed wool say the test is not validated and the larger screens are validated, but I have used it several times clinically because it only takes a few seconds. My father, who was a doctor born in 1905 , he believed in that test, “he said.
Hansen’s father, Hans Kraus, was a pain specialist who has been credited as the father of sports medicine in the US. He was an associate professor of clinical physical medicine and rehabilitation at New York University School of Medicine who became one of President John F. Kennedy’s physicians after successfully treating the president for his back problems. .
His obituary inside The New York Times lists an impressive variety of famous patients, including Kennedy, Katherine Hepburn, Eleanor Roosevelt, Arthur Godfrey, Yul Brynner, Rita Hayworth, Angela Lansbury, Oleg Cassini, Paulette Goddard, Robert F. Kennedy, and skier Billy Kidd, who credited the Dr. Kraus’ Treatments with the chance to win an Olympic gold medal.
“My father believed in hypnosis as a modality that could help selected patients,” Hansen explained, “and he did a little himself, but he sent most of his patients to psychiatrists or other professionals.
“Sometimes, I would use the eye roll test to determine if someone was hypnotizable and was a good candidate to pursue hypnosis as part of their treatment plan, to control pain and anxiety,” Hansen said.
“We are facing pain, and there is the mental component. In the brain, the pathways of pain, depression, anxiety, all of these overlap. Fifty years ago, people knew it intuitively and now they have demonstrated it in the laboratory, ”he added.
Kittle and Hansen have not revealed any relevant financial relationship.
2021 Annual Meeting of the American Academy of Pain Medicine (AAPM): Poster Educational Session 1. Presented April 23, 2021.