Background & Aims
Acute pain places a major burden on postoperative recovery, influencing the complication rate (1), the length of hospital stay (2) and risk of chronic postsurgical pain (3, 4). Enhanced recovery after surgery (ERAS) protocols have imposed multimodal pain management as standard of care (5, 6), and pharmacological methods, particularly opioids, as first-line treatments (7, 8).
Complementary methods, such as medical hypnosis, have been shown to decrease perioperative anxiety, pain and medication requirements (9, 10). Yet, this potentially helpful complementary analgesic therapy has seldom been studied in an acute post-operative setting.
The objective of the present study is to evaluate the efficacy of three short postoperative hypnosis sessions for reducing pain after major abdominal surgery.
Methods
The HypnERAS prospective randomized clinical trial (clinicaltrials.gov ref: NCT04645654) was conducted between October 2020 and June 2023, at Lausanne University Hospital, Switzerland. Adults (N= 176) expected to stay more than 7 days after major abdominal surgery were randomized 2:1 to a hypnosis and a control arm, single blind (care team blinded, patients and study team aware).
Eligible participants were randomized between day -1 and +3 of surgery and had 3 study visits between day +1 and +12. In the hypnosis arm, nurses delivered three different 30-minute scripted pain-focused sessions and audios recordings for self-hypnosis.
The primary outcome was the mean self-reported pain intensity at mobilization (visual analog scales measured by the care team). Secondary outcomes were the comparison of pain intensity, pain unpleasantness, anxiety, and comfort/well-being immediately before and after hypnosis, the length-of-stay and opioid consumption during hospital stay.
Results
The intention-to-treat analysis included N=123 patients in the hypnosis (HYP) and N=53 in the control arm (SOC), with similar baseline characteristics. Maximum daily pain scores on mobilization (means 2.98–4.89) were not significantly different between treatment arms. Pain was well controlled, with low intensity (means 2.68 – 4.89) reported at study visit initiation (no significant difference between arms). HYP participants reported significantly lower pain intensity after each session (all p’s?0.0001). Pain ratings in the HYP arm after hypnosis were compared to pain ratings in the SOC arm, with a significant main effect of treatment across the three visits (F(1,145.2)=3.9, p=0.04). The median daily opioid consumption was 246 mg in the HYP vs 180 mg in the SOC arm, without statistical difference. Yet, there was a significant interaction effect between time and groups with a lower opioid intake for patients who practiced self-hypnosis than those who did not (F(12,1106)=1.98, p=0.02).
Conclusions
We found no significant decrease of pain intensity at mobilization in the group that benefitted of 3 brief hypnosis sessions. Pain scores were overall low, suggesting good pain management, yet with substantial opioid doses, conflicting with ERAS goals and prevention of complications. Hypnosis was shown to bring reliable momentary pain relief (small effect size with all Cohen’s ? 0.29). Nevertheless, given good analgesia under opioids, patients may have had a weak incentive to use self-hypnosis. However, patients who did practice self-hypnosis had lower opiate use, suggesting this technique as a promising adjunct to optimize post-operative multimodal pain management in an opioid sparing perspective.
References
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Presenting Author
Sophie Walther-Lagger
Poster Authors
Sophie Walther-Lagger
Dr. med.
Lausanne University Hospital
Lead Author
Aimie Chiron
Center for Integrative and Complementary Medicine, CHUV, Switzerland
Lead Author
Nina Rimorini MSc
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Corine Guyaz
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Reza Djafarrian
Department of visceral surgery, Lausanne University Hospital, Lausanne, Switzerland
Lead Author
Jean-Benoît Rossel
Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
Lead Author
Martin Hübner
Department of visceral surgery, Lausanne University Hospital, Lausanne, Switzerland
Lead Author
Nicolas Demartine
Department of visceral surgery, Lausanne University Hospital, Lausanne, Switzerland
Lead Author
Eric Garland
University of Utah
Lead Author
Chantal Berna Prof. MD PhD
Center for Integrative and Complementary Medicine, Lausanne University Hospital
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain