Is hypnosis more effective than suggestive techniques in reducing postoperative pain?

Suggestive techniques work remarkably well for pain. Every child knows that an ouchie feels better after mom or dad gives it a kiss. Every pain researcher knows that placebos work, even though it is only through the suggestion that the patient may receive an active pain medicine. Not only are placebo’s effective analgesics, but in many trials they are so effective that the active drug isn’t demonstrably better.

There is a range of suggestive techniques to address acute pain, ranging from the simple placebo effect to formal hypnosis. Hypnotherapy requires training. Suggestions, otherwise known as suggestive interventions, are given without hypnosis, i.e., a formal hypnotic trance, and might also help to alleviate perioperative distress. Dr. Zoltán Kekecs, Department of Affective Psychology, Faculty of Psychology and Education, Eötvös Loránd University, Budapest, Hungary, and colleagues performed a meta-analysis on 26 randomized controlled trials assessing the effectiveness of hypnosis, “suggestive interventions,” or both on the occurrence of postoperative anxiety/distress, postoperative pain, postoperative pain medication requirement and postoperative nausea associated with surgical procedures. The results of their study are published in this month’s issue of Anesthesia & Analgesia and are discussed in the article “The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects: A Meta-Analysis of Randomized Controlled Trials.”

Of the 26 studies including 1890 patients that met inclusion criteria, 13 applied hypnosis, 11 applied suggestive interventions, and 2 applied both, 13 used live presentation while 13 used recorded presentation, and 14 were performed in major surgery versus 11 in minor surgery. Hypnosis was generally found to work better than suggestion for reducing patient-reported pain, and to a lesser extent on pain intensity for minor compared to major surgeries. Both methods worked on anxiety (hypnosis and live presentation were somewhat more effective), while neither hypnosis nor suggested interventions affected nausea or the actual consumption of analgesics postoperatively.

This well-conducted review demonstrates that the use of suggestive techniques can improve patient outcomes in a small way, through relief of anxiety and the perception of pain. While training in hypnosis is not likely to be part of the residency curriculum in the near future, the incorporation of suggestive language in the day-to-day patter of patient care might be an easy and cost-efficient way to improve patient centered outcomes.