Hypnosis can improve patients' pain experience

Tampa, Fla. - The pain patients perceive during and after dermatologic or cosmetic procedures can sometimes be difficult to manage. Hypnosis is one technique that can significantly calm patients before and during surgery, as well as substantially reduce - and possibly even eliminate - perioperative pain.

Hypnosis explained
Hypnosis is the intentional induction, deepening, maintenance and termination of the natural trance state for a particular purpose.

Medical hypnotherapy is employed across many medical specialties and is currently being used to treat - and even cure - a variety of dermatologic disorders such as acne, alopecia, herpes simplex, psoriasis, rosacea, trichotillomania and more. Hypnosis also has its place in dermatologic surgery, and it can be used alone or in combination with local anesthesia.

“Hypnosis can be a very powerful tool in controlling the pain associated in dermatologic and cosmetic procedures, and, in my opinion, is currently underused as an alternative or complementary therapy in the dermatologic practice,” says Philip D. Shenefelt, M.D., M.S., associate professor, department of dermatology and cutaneous surgery, University of South Florida College of Medicine, Tampa, Fla.

A patient who is highly hypnotizable can actually be made to feel local anesthesia so that there is no pain associated with surgery. Even intra-abdominal surgery can be performed with hypnotism as the sole anesthesia-inducing technique.

The ability to lessen and eliminate pain, however, depends on the level of the procedure performed and the “hypnotizability” of the patient. As a result, local anesthesia still may be required.

Hypnosis studies
Many studies support the use of hypnosis for perioperative pain control. In a meta-analysis of hypnotically induced analgesia, Montgomery et al quantified the magnitude of hypnoanalgesic effects in patients with headache, burn injury, heart disease, cancer, dental problems, eczema and chronic back problems. For most people, hypnotic suggestion was found to relieve pain regardless of its type (Montgomery, et al. Int J Clin Exp Hypn. 2000;48(2):138-153).

In another study, Montgomery et al found that 89 percent of patients who had hypnosis for different surgical procedures (breast biopsy, radiologic invasive procedures or head/neck surgeries) had a positive benefit from the hypnosis in regards to pain management compared to controls (Montgomery, et al. Anesth Analg. 2002;94(6):1639-1645).

Hypnosis and dermatology
In dermatologic surgery, hypnosis can reduce needle phobias, provide immediate and long-term analgesia and accelerate recovery from surgery. The technique is used in patients undergoing a biopsy, chemical peels, dermabrasion, sclerotherapy, liposuction, laser treatments or any procedure where the patient may be apprehensive and fearful of pain and the procedure itself.

According to Dr. Shenefelt, all of these procedures may be augmented by hypnotic relaxation and/or hypnotic analgesia, and some can be performed in combination with a local anesthetic.

“All individuals enter spontaneous mild trances daily while absorbed in watching television or a movie, or in another activity or meditation,” Dr. Shenefelt says. “However, it is possible to resist going into a trance state just like it is possible to resist going to sleep. Some physicians regularly use relaxation techniques such as guided imagery tapes or relaxing music, which have a very similar effect to hypnosis.”

Hypnosis induces a psychophysiological altered state of consciousness consisting of narrowed awareness, restricted and focused attentiveness, selective wakefulness and heightened suggestibility. In the majority of patients, a light-to-medium trance is sufficient to achieve pain control and management.

“Direct suggestion while in the hypnotic state is a frequently used method of decreasing discomfort from pain and anxiety when performing cosmetic procedures and may produce a sufficiently deep anesthesia in highly hypnotizable individuals,” Dr. Shenefelt says. In most patients, he says, a trance state can be induced in less than a minute.

Dr. Shenefelt often teaches his patients self-hypnosis so that in addition to their pain medication, they can use the technique when needed to help regulate and manage postoperative pain and discomfort.

Traditional techniques
Whether administered orally or through a local anesthetic pain pump or other sophisticated pain control device such as the ActiPatch (BioElectronics), pharmacologically based treatments have a proven efficacy in quelling the pain perceived after surgery.

According to Dr. Shenefelt, many people have been socialized through advertising to expect a pain pill to do the work for them. However, drugs may not always be the optimal choice because of an underlying medical condition, financial reasons or patients simply wanting an alternative technique to traditional drug therapies such as hypnosis or acupuncture.

“When properly applied, hypnosis is a technique that can be effective in many surgical patients for perioperative anxiety and pain control and can be used as an alternative technique in pain management. However, it is not a panacea, and though it appears to work miracles in some patients and fail completely in others, most patients will derive a good benefit from it,” Dr. Shenefelt says.

Disclosures: Dr. Shenefelt reports no relevant financial interests.