A randomized clinical of a brief hypnosis intervention to control side effects in breast surgery patients

American Journal of Clinical Hypnosis,  Jan 2008  by Wickramasekera, Ian II

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Montgomery, G.H., Bovbjerg, D.H., Schnur, J.B., David, D. Goldfarb, A., Weltz, C.R., Schnecter, C., Graff-Zivin, J., Tatrow, K., Price, D.D., & Silverstein, J.H. (2007). A randomized clinical of a brief hypnosis intervention to control side effects in breast surgery patients. Journal of the National Cancer Institute, 99(17), 1304-1312. This is another very important article from the lead author and his colleagues on the uses of hypnosis with breast cancer and breast surgery patients. In this study, the authors utilized a very brief intervention with patients prior to their experience of breast surgery to reduce their intra-operative pain, anxiety, and other post-surgical difficulties. The authors also wished to test how utilizing hypnosis in this brief fashion might reduce intra-operative anesthesia and medication utilization. The authors also wished to test whether the addition of hypnosis to the medical protocol that was employed may have reduced the overall costs of the breast surgical procedure they were scheduled for. The authors randomly selected 200 women who were undergoing excisional breast biopsy or lumpectomy to receive either a live, 15-minute hypnotic intervention or 15 minutes of a condition of non-directive empathic listening which served as an attention control for the experiment. The patients medication and anesthesia usage was monitored during and following the procedure as they were waiting in the recovery room. The patients' pain and other difficulties were assessed using a visual analog scale. The costs of each patient's operation were determined through a chart review following the procedure. The patients in the hypnosis group did report significantly less pain, nausea, fatigue, discomfort, and emotional difficulties compared to the empathic listening group. The patients in the hypnosis group also used less anesthesia and medication than the patients in the empathic listening group for some but not all of the pharmacological interventions that were tracked. The authors reported that the average cost per procedure per patient was around $8,500. The patients in the hypnosis group required significantly less time in the surgery suite and thus over $750 was saved per patient as a result of the utilization of hypnosis in their surgical procedure.

This study is another very important study to make your medical colleagues aware of given that the authors not only demonstrated that hypnosis is clinically effective, but also demonstrated that hypnosis was cost effective and saved the healthcare system a significant amount of money. I recently read that it is estimated that as many as 1,000,000 excisional breast biopsies are performed every year in the United States. The healmcare cost savings could therefore be estimated as being as much as 750,000,000 just from integrating 15 minutes of hypnosis prior to just this one type of surgery by itself. One can only imagine how many billions of dollars could potentially be saved if hypnosis were integrated prior to every surgical operation where it was deemed potentially useful and appropriate. I have occasionally encountered a benign interest from other medical professionals in utilizing the services of a psychologist in assisting medical patients that is tempered by concerns that adding hypnosis to a standardized medical procedure will lengthen and increases the costs of patient care. This study provides an excellent empirically grounded model of how to provide brief hypnotic interventions that not only provides the patient with the highest quality of concern for their quality of life as well as actually saving money compared to an empathic control condition that sadly could also be considered an improvement upon standard medical practice. In several other studies, the empathic listening group received some benefits similar to those seen in hypnosis. So it is possible that the hypnosis group's results may be even more dramatic if they were compared to a third standard of care group, which presumably also the empathic listening group would show some superiority over in terms of some of the outcome variables. Address for reprints: Guy H. Montgomery, Ph.D., Department of Oncological Sciences, Mount Sinai School of Medicine, Box 1130,1 Gustave L. Levy Place, New York, NY 10029-6574. Email address: guy.montgomery@mssm.edu.

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