Can medical hypnosis accelerate post-surgical wound healing? Results of a clinical trial

American Journal of Clinical Hypnosis, Apr 2003 by Ginandes, Carol, Brooks, Patricia, Sando, William, Jones, Christopher, Aker, John

Although medical hypnosis has a long history of myriad functional applications (pain reduction, procedural preparation etc.), it has been little tested for site-specific effects on physical healing per se. In this randomized controlled trial, we compared the relative efficacy of an adjunctive hypnotic intervention, supportive attention, and usual care only on early post-surgical wound healing. Eighteen healthy women presenting consecutively for medically recommended reduction mammaplasty at an ambulatory surgery practice underwent the same surgical protocol and postoperative care following preoperative randomization (n = 6 each) to one of the three treatment conditions: usual care, 8 adjunctive supportive attention sessions, or 8 adjunctive hypnosis sessions targeting accelerated wound healing.

The primary outcome data of interest were objective, observational measures of incision healing made at 1,7 weeks postoperatively by medical staff blind to the participants' group assignments. Data included clinical exams and digitized photographs that were scored using a wound assessment inventory (WAI). Secondary outcome measures included the participants' subjectively rated pain, perceived incision healing (VAS Scales), and baseline and post-surgical functional health status (SF-36).

Analysis of variance showed the hypnosis group's objectively observed wound healing to be significantly greater than the other two groups', p

Results of this preliminary trial indicate that use of a targeted hypnotic intervention can accelerate postoperative wound healing and suggest that further tests of using hypnosis to augment physical healing are warranted.

Key Words: Accelerated healing, behavioral medicine, hypnosis, mammaplasty, mind-body, relaxation techniques, wound healing.

Introduction

In the investigation of mind-body interactions, non-pharmacological, mental interventions have demonstrated diverse physiological effects on autonomic, endocrine, and immune functions (Zachariae, et al., 1990; Vollhardt, 1991; Benson, Arns, & Hoffman, 1981) as well as on positive psychological and physical health status changes (Brown & Fromm, 1987). Of these mental interventions, medical hypnosis has been shown useful in myriad functional applications including: preparation for surgery, shortening of hospital stays, and lessening of procedural anxiety, anticipatory emesis, intraoperative blood loss, and pain, etc. (Lynn, Kirsch, Barabasz, Cardena, & Patterson, 2000; Lang et al., 2000: Pinnell & Covino, 2000; Redd, Andresen, & Minagawa, 1982). Although the precise psychobiological pathways of such benefits require further clarification (Rossi, 1986), physiological studies have already revealed hypnotic mediation of regional cerebral blood flow, cortical activation, inflammatory response, and immune modulation (Crawford, Gur, Skolnick, Gur, & Benson, 1993; Williams & Gruzelier, 2001; De Pascalis, 1999; Miller & Cohen, 2001). These effects suggest that hypnosis can be useful for mitigating the stress response following a traumatic injury whether it is caused accidentally or surgically. Recent studies have shown that stress delays wound healing and surgical recovery (Glaser, et al.; 1999; Kiecolt-Glaser et al., 1995). Adjunctive hypnosis used to advantage in surgical recovery has been abundantly documented (Rapkin, Straubing, & Holroyd; 1991; Blankfield, 1991).

Such studies lead to the further hypothesis that hypnotic intervention could be utilized to augment not only functional recovery but also structural healing. This speculation is presumed in the current proliferation of preparation for surgery/speed healing programs (Huddleston, 1996), but it is a hypothesis that has been little tested in controlled studies. Such trials might illuminate the fundamental question as to whether mental input can, in fact, effect anatomical tissue change and accelerate site-specific healing.

The case literature has provided copious documentation of hypnotically augmented tissue healing in the domain of cutaneous conditions as such severe burns (Patterson, Goldberg, & Ehde, 1996). Ewin (1986) had extensively documented hypnotic burn care using suggestions to keep the "involved areas cool and comfortable" in the first few hours after a severe burn; these interventions have been clinically observed to attenuate burn depth and the size of the lesion and can apparently mediate the usual course of edema and inflammatory progression.

Other cutaneous applications of hypnosis have included the large literature on a wart removal (Ewin, 1992; Noll, 1988) and the amelioration of various dermatological diseases including ichythyosis (Kidd, 1966), psoriasis (Frankel & Misch, 1973), eczema (Goodman, 1962), and herpes simplex (Shenefelt, 2000). But the compelling evidence from such case reports has been handicapped by a dearth of research trials and methodological limitations such as lack of randomization and adequate control group comparisons.

In addition to studies of cutaneous diseases, there have been several studies exploring the use of hypnotic suggestions to induce or exacerbate medical symptoms. Graham (1962) hypnotized over 150 subjects and elicited autonomic reactions that led to the evocations of disorders including eczema, asthma, migraine headache, Raynaud's disease, and duodenal ulcer, etc. Chapman, Goodell, and Wolff (1959) reported on the modification of inflammatory and tissue damage using hypnotic suggestions following an experimentally induced bum. Bregman and McAllister (1985) reported on influencing digital skin temperature through suggestions, and Zachariae and Bjerring shared their use of hypnotic suggestions to mediate cutaneous reactions during sensitization (1993).