Self-Hypnosis May Aid Recovery Pathway For Patients After Surgery

Originally published by our sister publication Anesthesiology News

Patients who use self-hypnosis before undergoing surgery may experience lower anxiety levels and contribute to better recovery, according to a study presented during the 2024 annual meeting of the American Society for Enhanced Recovery and Perioperative Medicine (ASER PM).

“We knew that previous studies had suggested an association between preoperative anxiety and postoperative pain,” said Maria D. Iniesta-Donate, MD, PhD, an assistant professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center, in Houston. “So, we hypothesized that if we intervene to address this preoperative anxiety, we could decrease the patient experience of perioperative pain.”

The enhanced recovery team established a collaboration with Lorenzo Cohen, MD, the Richard E. Haynes Distinguished Professor in Clinical Cancer Prevention and director of the integrative medicine program at MD Anderson. Cohen and his team developed a 20-minute, prerecorded self-hypnosis audio file that was made available for patients to listen to before their surgical procedures.

Patients undergoing open surgery for a suspected gynecologic malignancy were randomized to either standard enhanced recovery care or standard enhanced recovery care plus self-hypnosis. The study’s primary outcomes were feasibility and efficacy, measured by patient-reported worst pain on postoperative day 1, using the MD Anderson Symptom Inventory-PeriOp-GYN assessment tool (on a 0-10 scale). Secondary outcomes included patient-reported anxiety, quality of life, symptom burden, time to first opioid, quality of recovery and morphine equivalent daily dose on postoperative days 0 to 3. Satisfaction with the self-hypnosis procedure was also evaluated.

The study included 138 patients who underwent an exploratory laparotomy for suspected gynecologic cancer, 71 of whom were randomized to the self-hypnosis group and asked to listen to the self-hypnosis audio file at least twice before their procedures (at the time of consenting and while in the preoperative holding area). The patients also had access to the file to use ad libitum in the days before surgery.

Although patients in the self-hypnosis cohort were younger than those in the standard enhanced recovery group, with a median age of 54 compared with 61 years, there were no significant differences regarding the type of anesthesia technique, surgical time, surgical complexity, estimated blood loss or opioids administered during surgery.

The self-hypnosis intervention was feasible and well tolerated. Patients in the enhanced recovery plus self-hypnosis arm reported significantly lower anxiety scores after listening to the self-hypnosis audio file.

However, the intervention did not influence postoperative pain. The researchers did not find any significant differences in self-reported worst pain, time to first opioid or median morphine equivalent daily dose on postoperative days 0 to 3 between the two study arms.

While the researchers stated an interest in future studies that will evaluate whether listening to the self-hypnosis audio file more frequently and in the postoperative setting can help reduce pain, they were satisfied that the intervention was deemed easy, enjoyable and helped reduce anxiety preoperatively.

“The self-hypnosis was well received by patients,” Iniesta-Donate said. “Patients found the process to be easy to complete, and there was a benefit. While there was no significant impact on pain, patients were able to decrease their anxiety and reported high levels of satisfaction with the self-hypnosis intervention. This is an important finding.”

Anoushka Afonso, MD, the president of ASER PM and director of enhanced recovery programs at Memorial Sloan Kettering Cancer Center, in New York City, predicted self-hypnosis could be a valuable tool in the future.

“I think hypnosis is a promising tool to improve various aspects of the perioperative experience,” said Afonso, who is a member of the Anesthesiology News editorial advisory board. “While research is ongoing as evidenced in this article, it really could be a very valuable adjunct to the traditional medical care in the perioperative setting.”

By Ethan Covey

Afonso and Iniesta-Donate reported no relevant financial disclosures. The study was funded by a Foundation for Women’s Cancer grant.