CoChat
Sign Up
Cited by 82Pain Management and Placebo EffectAnesthesia and Pain ManagementDental Anxiety and Anesthesia Techniques

The Effectiveness of Suggestive Techniques in Reducing Postoperative Side Effects: A Meta-Analysis of Randomized Controlled Trials

Kekecs, Zoltán, Nagy, Tamás, Varga, Katalin·2014·Anesthesia & Analgesia
DOI 10.1213/ane.0000000000000466
Open this paper in CoChat — free account

Abstract

BACKGROUND: Suggestive interventions such as hypnosis and therapeutic suggestions are frequently used to alleviate surgical side effects; however, the effectiveness of therapeutic suggestion intervention has not yet been systematically evaluated. In the present study, we tested the hypotheses that (1) suggestive interventions are useful for reducing postoperative side effects; (2) therapeutic suggestions are comparable in effectiveness to hypnosis; (3) live presentation is more effective than recordings; and (4) suggestive interventions would be equally effective used in minor and major surgeries. METHODS: We performed random effect meta-analysis with meta-regression and sensitivity analysis by moderating factors on a pool of 26 studies meeting the inclusion criteria (N = 1890). Outcome variables were postoperative anxiety, pain intensity, pain medication requirement, and nausea. RESULTS: Suggestive interventions reduced postoperative anxiety (g = 0.40; 99% confidence interval [CI] = 0.13-0.66; P < 0.001) and pain intensity (g = 0.25; 99% CI = 0.00-0.50; P = 0.010), but did not significantly affect postoperative analgesic drug consumption (g = 0.16; 99% CI = -0.16 to 0.47; P = 0.202) and nausea (g = 0.38; 99% CI = -0.06 to 0.81; P = 0.026). No significant differences were found for intervention type, presentation method, and severity of surgery; however, sensitivity analysis only supported the effectiveness of hypnosis (g = 0.62; 99% CI = 0.31-0.92; P < 0.001) and live presentation (g = 0.55; 99% CI = 0.23-0.88; P < 0.001) for decreasing postoperative anxiety, and that of live presentation for alleviating postoperative pain (g = 0.44; 99% CI = 0.07-0.82; P = 0.002). Sensitivity analyses also suggested that suggestive interventions are only effective for decreasing pain intensity during minor surgical procedures (g = 0.39; 99% CI = 0.00-0.78; P = 0.009). CONCLUSIONS: Suggestive techniques might be useful tools to alleviate postoperative anxiety and pain; however, strength of the evidence is weak because of possible bias in the reviewed articles. The lack of access to within-subjects data and the overlap between moderator conditions also limit the scope of the analysis. More methodologically correct studies are required with sensitivity to moderating factors and to within-subjects changes. For clinical purposes, we advise the use of hypnosis with live presentation to reduce postoperative anxiety and pain, until convincing evidence is uncovered for the effectiveness of therapeutic suggestions and recorded presentation. Pain management with adjunct suggestive interventions is mostly encouraged in minor rather than major surgeries.

Integrity signals

Registry

Crossref · 10.1213/ane.0000000000000466

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Meta-analysis indicates that suggestive interventions, including hypnosis and suggestion without hypnotic induction, result in significant, small effect size reductions in postoperative pain and anxiety.

    “Meta-analysis indicates that suggestive interventions, including hypnosis and suggestion without hypnotic induction, result in significant, small effect size reductions in postoperative pain and anxiety. 18”

    From Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. (2017) · cites this paper as [18]

  • In reviews including patients undergoing surgery, neither effects of anesthesia (local, general; Tefikow et al., 2013; Holler et al., 2021), nor type of surgery (diagnostic procedure vs. other, Kekecs et al., 2014; Holler et al., 2021) could be found.

    “In reviews including patients undergoing surgery, neither effects of anesthesia (local, general; Tefikow et al., 2013; Holler et al., 2021), nor type of surgery (diagnostic procedure vs. other, Kekecs et al., 2014; Holler et al., 2021) could be found.”

    From Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective (2024) · cites this paper as Kekecs et al., 2014

  • Moderator analyses on the mode of presentation yielded significantly larger effects for live presentations in comparison to audio recorded presentations (Schnur et al., 2008; Kekecs et al., 2014), but this was not the case in two other reviews (Tefikow et al., 2013; Holler et al., 2021).

    “Moderator analyses on the mode of presentation yielded significantly larger effects for live presentations in comparison to audio recorded presentations (Schnur et al., 2008; Kekecs et al., 2014). However, this was not the case in two other reviews (Tefikow et al., 2013; Holler et al., 2021).”

    From Meta-analytic evidence on the efficacy of hypnosis for mental and somatic health issues: a 20-year perspective (2024) · cites this paper as Kekecs et al., 2014

  • Only a handful of clinical hypnosis studies were rated as having low risk of bias across all assessed bias domains in the reviews.

    “Only a handful of clinical hypnosis studies were rated as having low risk of bias across all of these bias domains in the reviews.”

    From Best Practice Recommendations for Conducting and Reporting Controlled Trials in Clinical Hypnosis Research (2024) · cites this paper as [8]

  • Recent systematic reviews and meta-analyses have identified a considerable risk of bias in reviewed clinical hypnosis trials.

    “However, recently published systematic reviews and meta-analyses have identified a considerable risk of bias in the reviewed clinical trials.3,5-11”

    From Best Practice Recommendations for Conducting and Reporting Controlled Trials in Clinical Hypnosis Research (2024) · cites this paper as [8]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Kekecs, Z., Nagy, T., & Varga, K.
Affiliations
Eötvös Loránd University (HU)
Corresponding author
  • Kekecs, Zoltán
  • Varga, Katalin
ORCID
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-12
Volume
119
Issue
6
Pages
1407-1419
ISSN
0003-2999 (ISSN-L)
DOI
10.1213/ane.0000000000000466
OpenAlex
W2034487541
Cited by
82
References
39
Citations by year
2026: 1 · 2025: 12 · 2024: 7 · 2023: 2 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 8 · 2015: 8 · 2014: 1
FWCI
0.71
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
Keywords
therapeutic suggestion, hypnosis, postoperative anxiety, postoperative pain, postoperative nausea, analgesic use, surgical side effects, placebo effect, placebo analgesia
MeSH terms
Analgesics, Anxiety, Humans, Hypnosis, Postoperative Pain, Suggestion, Randomized Controlled Trials as Topic, Treatment Outcome, Postoperative Nausea and Vomiting, Mind-Body Therapies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review