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You are getting very sleepy…

Hypnosis is usually thought of as a stage show, or a way of helping people to quit habits like smoking. A woman being hypnotisedBut new research published in the Journal of the National Cancer Institute this week has suggested that hypnosis before breast cancer surgery may help to reduce the amount of anaesthetic needed, as well as reducing pain afterwards.

Hypnosis on trial
People having surgery for breast cancer often suffer side effects such as pain, feeling sick, and tiredness during and after their operation. These problems can lead to longer hospital stays, or needing additional treatment.

Researchers at the Mount Sinai School of Medicine in New York and their colleagues carried out a clinical trial to test hypnosis, using two hundred women randomly split into two groups. Half were given hypnosis by a psychologist before their surgery, while the others just talked to a psychologist. Randomised controlled trials like these are vital for ensuring that the results are reliable, and are important for upholding the scientific integrity of tests of unconventional approaches such as hypnotherapy.

In the trial, the women given hypnosis generally said they felt less pain, sickness, tiredness, and emotional upset after surgery, compared with the control group. They also spent less time in surgery, and needed less anaesthetic. And as well as improving things for patients physically and mentally, the researchers also found that the costs of surgery were cut by more than US$700 (around £350) per person.

Why does it work?
Hypnosis certainly isn’t a new idea in medicine. Way back in 1846, a Scottish surgeon called James Esdaile reported success using the technique as anaesthetic for surgery. With the subsequent development of more reliable and effective anaesthetics, hypnosis was ignored by the medical profession for the next 150 years, but this new evidence (as well as many other studies) may herald its welcome back into the fold.

It’s becoming increasingly clear that the mind can be a powerful tool in controlling pain, and that it can be trained to “float rather than fight”. However, the mechanisms by which hypnosis works aren’t entirely certain. Given that you appear to pay attention to pain for it to hurt, and hypnosis seems to divert attention away from pain, it’s likely that it is somehow bypassing the centres in the brain that are responsible for pain perception.

Could hypnosis have particular relevance for people with cancer? Perhaps so. In the words of Dr David Spiegel from Stanford University Medical School, who has written an insightful commentary on this research:

“Cancer is a disease that hijacks patients’ attention. Those coming for […] surgery are understandably anxious about the outcome. They are thus hyperattentive to every pain and its possible implications.”

So using hypnosis to redirect a patient’s attention might have particular benefits to people undergoing surgery for cancer.

What are we waiting for?
So if hypnosis can reduce pain and anxiety, and reduce drug use as well as surgical time and costs, why don’t we all do it? Perhaps it’s the suspicion within the medical profession – as well as the public – that hypnosis is the domain of flashy stage performers. But as more and more evidence is gathered to support its use, it may make sense for the NHS to examine the possibility of adopting hypnosis techniques, especially for people with cancer.

…And you’re back in the room.

Kat

Comments

Brandon Senior February 7, 2010

thankyou for the trouble you set into sharing it with me. great blog

Simon September 28, 2007

Thanks Kat – that’s a great discussion. I find the whole issue of placebo effects fascinating. I’d highly recommend Dylan Evans’ book on the subject: http://www.amazon.co.uk/Placebo-Mind-Matter-Modern-Medicine/dp/0007126131

Kat September 28, 2007

I’ve been meaning to read that for a while, I also find the whole area really interesting.

Simon September 28, 2007

Controlled – well, just about. But I was still argue that the aromatherapy trial was nevertheless much less robust than this one.

What I really like about this hypnotherapy trial is that those in the control group spent equal time talking with a psychologist as those in the hypnotism group. They even used the same psychologists to meet with both groups. There seems to have been a real effort to isolate the cause of any improvement. As far as possible, this implies that it really was the hypnotism that had the additional impact on outcomes, rather than being a placebo effect.

By contrast, in the aromatherapy trial, one group received aromatherapy massage, while the other received “usual supportive care alone”. It’s impossible to tell just from the abstract what that supportive care consisted of, but to make the trial even close to being valid, the care given to the control group would need to be equal in time to that spent on the massage. Even then, it doesn’t guarantee that the aromatherapy had anything to do with it. A previous, smaller trial in a hospice setting suggested that massage with inert carrier oils only was as effective as with fragranced aromatherapy oils: http://snurl.com/1rdcb One trial relying on inhalation rather than massage even found that the use of fragranced rather than plain carrier oils actually increased anxiety: http://snurl.com/1rdd1

Kat September 28, 2007

That’s a good point, and I agree that when doing trials for complemetary therapy, it’s important to think about the control. The placebo effect is incredibly strong. There’s an interesting debate about this going on at the BadScience blog, run by Dr Ben Goldacre, where he discusses some new results in acupuncture.
http://www.badscience.net/?p=540

Kat September 28, 2007

Thanks for your comment. Actually, Professor Ramirez’s aromatherapy trial was controlled:
http://blog.cancerresearchuk.org/scienceupdate/?p=7 There were two arms of 100 patients each, one group got aromatherapy massage while the others didn’t.

With regard to acupuncture, you may be interested to know that Cancer Research UK is funding Professor Lesley Fallowfield down at the University of sussex to carry out a controlled trial of acupuncture for relieving the side effects of radiotherapy for head and neck cancer. There is some evidence that acupunture can help with the side effects – severe dry mouth caused by damage to the salivary glands – as current drug treatments aren’t very effective. so this trial will put acupuncture to the test in a controlled trial setting.

There’s also a bit more about acupuncture and cancer on CancerHelp UK:
http://cancerhelp.cancerresearchuk.org/about-cancer/treatment/complementary-alternative/therapies/acupuncture

Simon September 27, 2007

Interesting stuff – and it’s good to see that there was an effort made to have a proper control group, unlike in the trials on aromatherapy that you blogged last month.

On the subject of complementary medicine, there were some interesting reports this week about the use of acupuncture for controlling back pain (though sticking needles into random bits of the body had as good an effect as “proper” acupuncture points). What’s the situation with using acupuncture in the realm of cancer? I seem to recall reading somewhere that there’s some evidence it can have good effects on controlling pain.