A Randomized Clinical Trial of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients

Department of Health Policy and Management, Columbia University, New York, New York, United States
Journal of the National Cancer Institute (Impact Factor: 12.58). 10/2007; 99(17):1304-12. DOI: 10.1093/jnci/djm106
Source: PubMed


Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective.
We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review.
Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time.
Hypnosis was superior to attention control regarding propofol and lidocaine use; pain, nausea, fatigue, discomfort, and emotional upset at discharge; and institutional cost. Overall, the present data support the use of hypnosis with breast cancer surgery patients.

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Available from: Donald D Price, Mar 27, 2015
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    • "Acupuncture has also been found beneficial in cancer-related vasomotor symptoms [110] and anxiety associated with hot flashes [111] and other symptoms associated with cancer such as pain, nausea and vomiting, fatigue that could be related to stress [112]. Another MBM technique, hypnosis, combined with cognitive behavioral therapy prevented the increase of fatigue in breast cancer patients compared to standard medical care during radiation therapy [113] and reduced fatigue in women who underwent lumpectomy for breast cancer [114]. "
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    Evidence-based Complementary and Alternative Medicine 07/2012; 2012(2):979213. DOI:10.1155/2012/979213 · 1.88 Impact Factor
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    • "These results support the position that hypnosis interventions in the cancer setting are likely to be acceptable to a broad spectrum of patients. Given the clinically beneficial effects of hypnosis to control side effects in the cancer setting (e.g., Lang et al., 2006; Montgomery et al., 2007), the stage appears to be set for broader application of hypnosis. "
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    The American journal of clinical hypnosis 10/2010; 53(2):93-100. DOI:10.1080/00029157.2010.10404331 · 0.53 Impact Factor
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    • "Second, poorly treated pain has been shown to be associated with cardiovascular and immune system dysfunction (Kehlet, 1997), and there is evidence that adequate pain management may facilitate long-term healing and recovery (Patterson, Tininenko, et al., 2006; Ptacek, Patterson, Montgomery, Ordonez, & Heimbach, 1995). Last, there is evidence that treating acute pain effectively can result in substantial reductions in medical costs (Lang & Rosen, 2002; Montgomery et al., 2007). "
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