Hypnosis for surgical procedures (2025)
Elvira V. Lang-Anderson
Hypnalgesics, LLC, Comfort Talk, Brookline, MA, USA
Jörgen Bruhn
Radboud University Medical Center, Nijmegen, The Netherlands
Web: comforttalk.com
Disclosure: EVLA is founder and owner of Comfort Talk®
Keywords: anxiety, hypnosis, pain, surgery
In the early 19th century, the surgeons Elliotson, Cloquet, and Esdaile reported using hypnosis for “painless” operations. At that time, the only options for surgical pain management were hypnosis or no hypnosis; anesthesia (ether) wasn’t introduced into practice until 1846. While there have been anecdotal reports of using hypnosis alone without local anesthesia for major open surgery on the torso, it is rarely done. However, for superficial or peripheral surgery, minimally invasive surgery, invasive medical procedures, childbirth, and dental surgery, hypnotic interventions are increasingly used for improved patient experiences with regard to distress management, need for drugs, and recovery (Montgomery et al., 2002; Noergaard et al., 2019; Thompson et al., 2019).
In addition to traditional hypnotic techniques (Faymonville et al., 1995), self-hypnotic relaxation scripts (Comfort Talk®; Lang 2019) and conversational hypnosis are also used perioperatively. For healthcare providers, establishing good rapport with patients, both verbally and non-verbally, avoiding negative suggestions, utilizing positive suggestions, reframing, metaphors, and imagination have become powerful tools in the perioperative setting (Varelmann et al., 2010).
During invasive medical procedures, pain and anxiety trend up over time when standard care is administered, as shown in randomized clinical trials (Lang et al., 2000; Lang et al., 2014). In these trials, pain escalation occurred regardless of the severity of the procedure or the amount of medication administered and occurred in a variety of procedures with different levels of invasiveness and risk, such as vascular/renal interventions, breast biopsies, and tumor embolizations (Lang et al., 2014). When patients were read a brief self-hypnotic relaxation script at the onset of these procedures, pain no longer increased over time, even in cases that lasted hours. This implies a fundamental change in pain processing can be achieved through a short set of suggestions at a time when the patient is exposed to ambiguous and potentially painful stimuli. Patients who had the script read to them experienced less anxiety, required fewer drugs, had more stable vital signs, fewer complications, and were discharged sooner. A short preoperative hypnosis script also decreased postoperative opioid use in a randomized trial of patients having total knee arthroplasty (Markovits et al., 2022).
Perhaps the success of conversational hypnosis begins with the surgical patient, who is already in a state of perioperative stress that may be conducive to heightened awareness and suggestibility (Cheek, 1962). The level of hypnotizability may similarly affect the mode and intensity of patient engagement in the hypnotic process (Thompson et al., 2019). While highly hypnotizable individuals may be more prone to imagine the worst but may be better at reframing such imagery, low-hypnotizable individuals start with less frightening imagery at the onset and can benefit from the relaxing elements of hypnosis; ultimately, both high- and low-hypnotizable individuals can benefit (Montgomery et al., 2002). Recognizing the limitations and cost of a solely drug-oriented approach to the management of surgical distress and greater openness of the public towards holistic approaches, the time may have come for more widespread use of hypnotic techniques in the operating room.
References
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