A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients
Abstract
BACKGROUND: Breast cancer surgery is associated with side effects, including postsurgical pain, nausea, and fatigue. We carried out a randomized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective. METHODS: We randomly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy (mean age 48.5 years) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening (attention control). Patients were not blinded to group assignment. Intraoperative anesthesia use (i.e., of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam) was assessed. Patient-reported pain and other side effects as measured on a visual analog scale (0-100) were assessed at discharge, as was use of analgesics in the recovery room. Institutional costs and time in the operating room were assessed via chart review. RESULTS: Patients in the hypnosis group required less propofol (means = 64.01 versus 96.64 microg; difference = 32.63; 95% confidence interval [CI] = 3.95 to 61.30) and lidocaine (means = 24.23 versus 31.09 mL; difference = 6.86; 95% CI = 3.05 to 10.68) than patients in the control group. Patients in the hypnosis group also reported less pain intensity (means = 22.43 versus 47.83; difference = 25.40; 95% CI = 17.56 to 33.25), pain unpleasantness (means = 21.19 versus 39.05; difference = 17.86; 95% CI = 9.92 to 25.80), nausea (means = 6.57 versus 25.49; difference = 18.92; 95% CI = 12.98 to 24.87), fatigue (means = 29.47 versus 54.20; difference = 24.73; 95% CI = 16.64 to 32.83), discomfort (means = 23.01 versus 43.20; difference = 20.19; 95% CI = 12.36 to 28.02), and emotional upset (means = 8.67 versus 33.46; difference = 24.79; 95% CI = 18.56 to 31.03). No statistically significant differences were seen in the use of fentanyl, midazolam, or recovery room analgesics. Institutional costs for surgical breast cancer procedures were $8561 per patient at Mount Sinai School of Medicine. Patients in the hypnosis group cost the institution $772.71 less per patient than those in the control group (95% CI = 75.10 to 1469.89), mainly due to reduced surgical time. CONCLUSIONS: 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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In a rigorous US trial, a brief hypnosis session before breast cancer surgery had an impact on patients' need for pain medications and the level of postoperative pain, nausea, exhaustion, and discomfort, with moderate to large effect sizes.
“In that trial, a brief hypnosis session before breast cancer surgery had an impact on the patients’ need for pain medications and the level of postoperative pain, nausea, exhaustion, and discomfort, with moderate to large effect sizes.”
The pre-operative hypnosis protocol is identical to the study being replicated.
“The pre-operative hypnosis protocol is identical to the study we are replicating [40].”
The concern about demand characteristics and response expectancies may be partly mitigated by the analgesic effects of hypnosis on behavioural measures found here, and on objective biomarkers and reduced medication requests in previous studies.
“This concern may be partly mitigated by the analgesic effects of hypnosis for behavioural (threshold/tolerance) measures found here, and on 'objective' biomarkers such as altered brain activity in the pain matrix (Del Casale et al., 2015) and reduced medication requests in clinical settings (Lang et al., 2000; Montgomery et al., 2007) in previous studies.”
From The effectiveness of hypnosis for pain relief: a systematic review and meta-analysis of 85 controlled experimental trials (2019) · cites this paper as Montgomery et al., 2007
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- Authors
- Montgomery, G. H., Bovbjerg, D. H., Schnur, J. B., David, D., Goldfarb, A., Weltz, C. R., Schechter, C., Graff-Zivin, J., Tatrow, K., Price, D. D., & Silverstein, J. H.
- Affiliations
- Albert Einstein College of Medicine (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-08-28
- Volume
- 99
- Issue
- 17
- Pages
- 1304-1312
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2127020060
- Semantic Scholar
- 57011573f623483e2936ef0a38f4369a4847d6d4
- Cited by
- 292
- References
- 47
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 9 · 2023: 11 · 2022: 19 · 2021: 17 · 2020: 12 · 2019: 17 · 2018: 12 · 2017: 24 · 2016: 19 · 2015: 10 · 2014: 22 · 2013: 15 · 2012: 18
- FWCI
- 8.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Cancer Institute (CA81137, CA105222)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- hypnosis, breast cancer surgery, postoperative pain, nausea, fatigue, propofol, lidocaine, fentanyl, midazolam, breast-conserving surgery, cost-effectiveness, patient-reported outcomes, attentional control, sedation, analgesia, operating room time
- MeSH terms
- Breast Neoplasms, Costs and Cost Analysis, Female, Humans, Hypnosis, Mastectomy, Middle Aged, Postoperative Complications, Mastectomy, Segmental, Treatment Outcome, Patient Selection
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