Hypnosis and Surgery

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Hypnosis and Surgery
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Two or Three words can have a profound change in
ones life. Our words have a profound
effect. What and How we say our words will
impact our ability to heal.
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This shot is gonna hurt, hang on!
I think you will be pleasantly surprised how
little discomfort there will be..
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In the 19th century, John Elliotson and James
Esdaile reported the successful use of mesmeric
somnambulism as an anesthetic for surgery.
Ether and chloroform soon proved to be more
reliably effective.
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Beyond Placebo

• Hypnosis is not placebo
• Hypnosis itself has its own placebo effects
• Hard to control for placebo in hypnosis studies

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fMRI Neurostructure theory Functional magnetic
resonance images (fMRI) elicited by thermal pain
in hypnotized subjects.
Schulz-Stubner S, Krings T, Meister IG, Rex S,
Thron A, Rossaint R.Regional Anesthesia and Pain
Medicine - Volume 29, Issue 6 (November 2004)
Department of Anesthesia, University of Iowa
Hospitals and Clinics, 200 Hawkins Drive, 6 JCP,
Iowa City, IA 52242-1079, USA. Sebastian-schulz-st
ubner_at_uiowa.edu
Our observations indicate that clinical hypnosis
may prevent nociceptive inputs from reaching the
higher cortical structures responsible for pain
perception. Whether the effects of hypnosis can
be explained by increased activation of the left
anterior cingulate cortex and the basal ganglia
as part of a possible inhibitory pathway on pain
perception remains speculative given the
limitations of our study design.
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fMRI Neurostructure theory
Current studies include functional brain imaging.
Rainville and his associates showed that
strategically worded suggestions can dissociate
the two components of pain, selectively altering
one but not the other. (Rainville, Duncan, Price,
Carrier, Bushnell, 1997). The two components
of pain have different biological substrates
sensory pain in the primary somatosensory cortex,
and suffering in the anterior cingulate cortex.
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pain intensity coding
Hypnosis works here
prediction of the sensory consequences of
pain-related action
the onset uncertainty of the impending stimuli
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Laparoscopy under local anaesthesia and
hypnoanaesthesia about 35 cholecystectomies and
15 inguinal hernia repair T. Séfiani a, M. Uscain
b, J.-L. Sany c, D. Grousseau b, P. Marchand
a,, D.Villate a, J.-L.Vincent a Annales
Françaises dAnesthésie et de Réanimation 23
(2004) 10931101
Laparoscopic surgery for cholecystectomy and
hernia repair under local anesthesia with
hypnosis were performed with conversion to
general anesthesia if patients showed signs of
discomfort. Results. Of the 35
cholecystectomies performed, 13/35 needed convert
to general anaesthesia, mainly for peritoneal
pain induced by CO2 insufflation 22/35
procedures were completed with patients
satisfaction. Upon 15-hernia repairs, only one
patient needed convert to general anaesthesia,
for dissection difficulty. Conclusion. Hypnosis
probably cannot be used routinely for
intraperitoneal laparoscopic procedures but
hypnosis for extraperitoneal laparoscopic hernia
repair should be further explored.
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Hypnosis Reduces Preoperative Anxiety in Adult
Patients Anesth Analg 20061021394 6 Haleh
Saadat, MD, Jacqueline Drummond-Lewis, MD, Inna
Maranets, MD, Deborah Kaplan, Anusha Saadat,
Shu-Ming Wang, MD, and Zeev N. Kain, MD Center
for the Advancement of Perioperative Health,
Departments of Anesthesiology, Pediatrics, and
Child Psychiatry Yale University School of
Medicine, New Haven, Connecticut
Randomized into 3 groups, a hypnosis group (n
26) who received suggestions of well-being an
attention-control group (n26) who received
attentive listening and support without any
specific hypnotic suggestions and a standard of
care control group (n 24). On entrance to the
operating rooms, the hypnosis group reported a
significant decrease by 56 whereas the
attention-control group reported an increase of
10 in anxiety and the control group reported an
increase of 47 in their anxiety (P 0.001).
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Hypnosis Reduces Preoperative Anxiety in Adult
Patients Anesth Analg 20061021394 6 Haleh
Saadat, MD, Jacqueline Drummond-Lewis, MD, Inna
Maranets, MD, Deborah Kaplan, Anusha Saadat,
Shu-Ming Wang, MD, and Zeev N. Kain, MD Center
for the Advancement of Perioperative Health,
Departments of Anesthesiology, Pediatrics, and
Child Psychiatry Yale University School of
Medicine, New Haven, Connecticut
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Hypnosis Reduces Distress and Duration of an
Invasive Medical Procedure for Children Pediatrics
2005115e77-e85 Lisa D. Butler, Barbara K.
Symons, Shelly L. Henderson, Linda D. Shortliffe
and David Spiegel
Hypnotic relaxation may provide a systematic
method for improving the overall medical care of
children with urinary tract abnormalities who
undergo VCUG. The results of this study suggest
that hypnosis provides a systematic, noninvasive
method for reducing distress and resistance to
VCUG procedures for children and their families,
as well as reducing staff time and strain in
administering such procedures. Because the VCUG
is an essential part of the evaluation of urinary
tract infections and vesicoureteral reflux in
children, improved relaxation and decreased
anxiety during the procedure may improve patient
and family compliance with initial as well as
follow-up evaluations for this condition.
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Hypnosis Reduces Distress and Duration of an
Invasive Medical Procedure for Children Pediatrics
2005115e77-e85 Lisa D. Butler, Barbara K.
Symons, Shelly L. Henderson, Linda D. Shortliffe
and David Spiegel
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A Randomized Clinical Trial of a Brief Hypnosis
Intervention to Control Side Effects in Breast
Surgery Patients Guy H . Montgomery , Dana H .
Bovbjerg , Julie B . Schnur , Daniel David ,
Alisan Goldfarb , Christina R. Weltz , Clyde
Schechter , Joshua Graff-Zivin , Kristin Tatrow ,
Donald D . Price , Jeffrey H. Silverstein J Natl
Cancer Inst Issue 17 September 5, 2007 1304
12 Vol. 99,
200 patients to undergo excisional breast biopsy
or lumpectomy were randomly assigned to a
15-minute presurgery hypnosis session conducted
by a psychologist or nondirective empathic
listening as a control. Intraoperative
anesthesia use lidocaine, fentanyl and the
sedatives propofol and midazolam was assessed.
Patient-reported pain and other side effects on a
visual analog scale as was use of analgesics in
the recovery room. Institutional costs and time
in the operating room were assessed via chart
review. 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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A Randomized Clinical Trial of a Brief Hypnosis
Intervention to Control Side Effects in Breast
Surgery Patients Guy H . Montgomery , Dana H .
Bovbjerg , Julie B . Schnur , Daniel David ,
Alisan Goldfarb , Christina R. Weltz , Clyde
Schechter , Joshua Graff-Zivin , Kristin Tatrow ,
Donald D . Price , Jeffrey H. Silverstein J Natl
Cancer Inst Issue 17 September 5, 2007 1304
12 Vol. 99,
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A Randomized Clinical Trial of a Brief Hypnosis
Intervention to Control Side Effects in Breast
Surgery Patients Guy H . Montgomery , Dana H .
Bovbjerg , Julie B . Schnur , Daniel David ,
Alisan Goldfarb , Christina R. Weltz , Clyde
Schechter , Joshua Graff-Zivin , Kristin Tatrow ,
Donald D . Price , Jeffrey H. Silverstein J Natl
Cancer Inst Issue 17 September 5, 2007 1304
12 Vol. 99,
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Adjunctive self-hypnotic relaxation for
outpatient medical procedures A prospective
randomized trial with women undergoing large core
breast biopsy.
Elvira V. Lang et.al. Pain 126 (2006) 155164
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Adjunctive self-hypnotic relaxation for
outpatient medical procedures A prospective
randomized trial with women undergoing large core
breast biopsy.
Elvira V. Lang et.al. Pain 126 (2006) 155164
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Group Therapy and Hypnosis Reduce Metastatic
Breast Carcinoma Pain DAVID SPIEGEL, MD AND
JOAN R. BLOOM, PH.D Psychosomatic Medicine Vol.
45, No. 4 (August 1983)
The pain and mood disturbance of 54 women with
metastatic carcinoma of the breast were studied
over the course of one year. A random sample was
offered weekly group therapy during the year,
with or without self-hypnosis training directed
toward enhancing their competence at mastering
pain and stress related to cancer. Both treatment
groups demonstrated significantly less self-rated
pain sensation (t 2.5p lt 0.02) and suffering (t
2.17, p lt 0.03) than the control sample. Those
who were offered the self-hypnosis training as
well as group therapy fared best in controlling
the pain sensation (F 3.1, p lt 0.05). Pain
frequency and duration were not affected. Changes
in pain measures were significantly correlated
with changes in self-rated total mood disturbance
on the Profile of Mood States and with its
anxiety, depression, and fatigue subscales.
Possible mechanisms for the effectiveness of
these interventions are discussed.
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Group Therapy and Hypnosis Reduce Metastatic
Breast Carcinoma Pain DAVID SPIEGEL, MD AND JOAN
R. BLOOM, PH.D
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THE EFFECT OF HYPNOTHERAPY ON PROCEDURAL PAIN AND
STATE ANXIETY RELATED TO PHYSIOTHERAPY IN WOMEN
HOSPITALIZED IN A BURN UNIT Ali Amini Harandi,
Akram Esfandani and Fereshteh Shakibaei Department
of Psychiatry, Isfahan Medical University,
Iran Contemporary Hypnosis (2004)Vol. 21, No. 1,
2004, pp. 2834
The mean ages of the intervention and control
groups were 30.5 12.1 and 36.6 16.6 years,
respectively (P 0.26). The total body surface
area that was burned (TBSA) was 30.2 11.3 in
the control group and 27.1 9.3 in the
intervention group (P 0.33). Twenty-nine
patients had second and third degree burns (66).
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Labor Pain
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Pre-operative preparation
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Pre-op

• Stress that you are with them. They are not
  alone.
• Use a relaxation technique for induction.
• Dissociation body here, mind there
• Stress words feeling good, comfortable and
  happy
• Use the words sleep
• Place in suggestions for thirst and hunger after
  abdominal surgery unless contra-indicated.

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Pre-op

• Use a breathing technique to discourage
  atelectasis.
• Use specific post hypnotic suggestions tied to
  the surgery. When you have your surgery and
  awake from anesthesia
• Tie in a posthypnotic suggestion for pain control
  to simple every day activity.

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Pre-op

• Augment the drugs. Your medication can be a
  signal to start a pleasant daydream in a safe and
  pleasant location of your choosing
• Augment the procedure. The whole operating area
  in your body becomes limp, soft and comfortable
  throughout the procedure and afterwards.
• Augment the recovery room. You will awake as
  from a restful and restorative deep sleep,
  pleasantly surprised to find the operation
  complete and the healing beginning

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Pre-op

• You will recover quickly, completely and
  comfortably.
• You will be pleased to see how easily you can
  pass water, breathe deeply and move your bowels.
• You will be pleasantly surprised to see how
  quickly you will feel like yourself again

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Pre-op

• Use a queue for post operative pain control.
• Eg. When the nurse, doctor or others touch you
  on either shoulder like this touch the shoulder
  you will instantly receive a boost of your own
  natural pain medicine found within.
• Use guided imagery of a controller and adjust
  the discomfort to a level that is best for you.
• Remind the patient discomfort is an alarm to
  notify the body of a problem and has done its job
  well. It is no longer needed unless there is a
  new development. Your body will let you know and
  you will become aware of any new developments.

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Intra-operative care
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During the operation

• From this time forward you will pay attention to
  only a voice that specifically calls you by name
  first. The rest of the conversations become
  gibberish and unimportant.
• Mr/Mrs X your operation is complete and you can
  look forward to getting better fast. You will
  awake now in your own time All your bodily
  functions will return rapidly as the anesthesia
  wears off.

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Research
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pain scale (VAS/NRS) was reviewed with the
participant IV catheter was placed headphones
placed with music or hypnotic suggestion randomly
assigned 50 mcg of Fentanyl, 3 mg of Midazolam,
100 mg of Propofol, and 8 mg of Decadron 200 mcg
of Glycopyrolate, (an antisialogogue given to dry
up the oral cavity ) IV Propofol amount was
recorded in milligrams on the operative record
VAS/NRS reviewed upon discharge VAS/NRS
reviewed by phone on the first postoperative
day prescription pain relievers use documented
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treatment (n 46) control (n 54)
EFFECTS OF HYPNOSIS AS AN ADJUNCT TO INTRAVENOUS
SEDATION FOR THIRD MOLAR EXTRACTION A
Randomized, Blind, Controlled Study EDWARD F.
MACKEY West Chester University of Pennsylvania,
West Chester, Pennsylvania, USA Intl. Journal of
Clinical and Experimental Hypnosis, 58(1) 2138,
2010
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EFFECTS OF HYPNOSIS AS AN ADJUNCT TO INTRAVENOUS
SEDATION FOR THIRD MOLAR EXTRACTION A
Randomized, Blind, Controlled Study EDWARD F.
MACKEY West Chester University of Pennsylvania,
West Chester, Pennsylvania, USA Intl. Journal of
Clinical and Experimental Hypnosis, 58(1) 2138,
2010
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EFFECTS OF HYPNOSIS AS AN ADJUNCT TO INTRAVENOUS
SEDATION FOR THIRD MOLAR EXTRACTION A
Randomized, Blind, Controlled Study EDWARD F.
MACKEY West Chester University of Pennsylvania,
West Chester, Pennsylvania, USA Intl. Journal of
Clinical and Experimental Hypnosis, 58(1) 2138,
2010
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EFFECTS OF HYPNOSIS AS AN ADJUNCT TO INTRAVENOUS
SEDATION FOR THIRD MOLAR EXTRACTION A
Randomized, Blind, Controlled Study EDWARD F.
MACKEY West Chester University of Pennsylvania,
West Chester, Pennsylvania, USA Intl. Journal of
Clinical and Experimental Hypnosis, 58(1) 2138,
2010
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Post Operative
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Post Op

• Pain control use controllers.
• Post Hypnotic suggestions and cues.
• Ongoing positive statements. getting better each
  day and in everyway
• PT, OT, Nursing to learn positive persuasive
  language skills.
• Stress discomfort not pain.

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