William T.G. Morton:
Many consider him to be the inventor of anesthesia

Perhaps. Enter an operating room, and patients are a lot more likely to be getting pain and anxiety medicines through intravenous tubes rather than mentally focusing on pleasant, safe images. It's as old as William T.G. Morton. When you want to cut the pain and still the anxiety of surgery, you use chemicals.

Radiologist Elvira Lang with a patient. Courtesy: Beth Israel Deaconess Medical Center

That could change, courtesy of ongoing scientific investigations of hypnosis. Although the practice is often derided as quackery, a new study shows that hypnosis can reduce the need for meds -- and make surgery faster and smoother.

In the study, Elvira Lang, now at Beth Israel Deaconess Medical Center in Boston, found that patients undergoing minimally invasive surgery who focused their minds on a safe, comfortable and relaxing place -- and did not hear suggestions that the procedure might hurt -- needed only half as much medicine for anxiety and pain, compared to patients receiving standard care.

You are getting sleepy. You are getting VERY sleepy...
That's right -- we're talking hypnosis. But this is not a circus sideshow: It's legit science. Lang's study was published in The Lancet, a venerable British medical journal named for a short, squarish surgical blade used for cutting human flesh, not a touchy-feely, New Age rag peppered with dreamy ads for aromatherapy and past life retrieval.

And Lang teaches at Harvard Medical School, the acme of academic medicine, and directs the division of interventional radiology at Beth Israel Deaconess.

We knew you'd ask. Interventional radiology is minimally invasive surgery done with tools guided by ultrasound, X-rays or CT scanners. Typical operations include repairs to bile ducts, blood vessels or kidneys. Patients are usually sedated but do not get general anesthetic.

Anesthetics are rightly given credit for helping make surgery a humane art, but they exact a cost: they can cause fatigue and confusion, circulatory problems, and the odd death. In other words, anesthetics are great when you need them, but less can be more.

You will feel no pain. You will feel no pain...
Digression digested? What did Lang find? Half the hypnosis group decided to take no medicines at all. And heart rate, blood pressure and blood oxygen levels remained more stable among the hypnosis patients, so their surgeries went significantly faster.

Before we get to the details, what are we talking about? Lang defines hypnosis as "a state of absorption, being caught up in your mind. It's like reading a book or watching a movie. You know there are people around you, but you are focused on one thing."

Focus, she says, explains why athletes can compete while injured. "They can keep going because they are caught up in the game. Only after they reach the locker room do they realize how much it hurts."

You will study hypnosis. You will study hypnosis...
To research the effectiveness of hypnosis, Lang and colleagues obtained the consent of 241 patients scheduled for interventional radiology operations. They randomly divided the patients into three groups:

The control group got standard care.

The "attention" group got attention from a medical personnel trained in hypnosis. The purpose of the group was to distinguish the effects of hypnosis from those of simply having a caring individual around during surgery.

The hypnosis group got attention from a hypnotist, who helped patients focus on positive images during surgery.

In the attention and hypnosis groups, medical personnel refrained from making negative suggestions. Instead of saying, "This is gonna hurt you like no tomorrow," they would suggest "You may feel a little warmth."

You will become a hypnotist. You will become a hypnotist...
For all its mystical allure, the hypnosis was done rather simply. And instead of hiring Dr. Demento, Lang trained grad students and nurses to calmly ask the patient to take some deep breaths, imagine that they were floating, and then go to a safe, secure location. To keep the patient's attention focused on the safe place, the hypnotist might ask. "Who else was there? What did you see? What did it smell like?"

While side-show hypnotists look for the people who can enter a monster trance -- and ignore the fact that they are behaving like fools before a guffawing audience -- minimally invasive surgery has lower requirements, Lang says, meaning that more people can benefit. Curiously, more anxious people are often easy to hypnotize, she adds. "You are anxious because you're thinking of a bad scenario. You can use the same ability of mind to ... make a better scenario."

Some patients found security in strange places. One woman floated above the Earth chatting with her deceased loved ones. One man "went fishing" with the entire surgical crew while a woman canned vegetables in her kitchen. (We did mention that the study was done at the University of Iowa...)

Speaking of canning, Lang's hypnotic method avoided canned images and instead relied on the patient's images, Lang says. "You have to be careful. One-quarter of patients will go to the water, but some patients are seriously afraid of the water. You don't know the baggage people bring" to various images.

You are reading the results. You are reading the results...
When reduced to cold numbers, these effects were statistically significant:

As the operation wore on, the level of pain remained stable in the hypnosis group, but grew steadily more intense in the other two.

The control group averaged about twice as much drug intake as the other groups. (Within safe limits, study participants controlled their intake of pain and anxiety meds during surgery.)

One hypnosis patient had cardiovascular problems during the operation, compared to 12 control patients.

The procedure time averaged 61 minutes in the hypnosis group, compared to 78 minutes in the control group.

There are other benefits to controlling pain without medication, Lang says. For example, day-surgery patients can drive home, and even return to work, if they haven't gotten meds. For some patients, the benefits increase over time. One man who faced repeated operations to replace a bile duct was convinced to try hypnosis even though he'd asked for a general anesthetic. By his third procedure, he barely needed coaching to drift off during the operation.

We Why Filers tend toward the mechanistic. We want to know how this thing works, and while Lang had carefully answered every other question, she only laughed and responded "Who knows?" Studies of the effect of hypnosis on the brain are under way, she added. "It's high time these things were evaluated in a scientific fashion."

But in her field -- interventional radiology -- effectiveness should be sufficient. The field is young, she says and "Very pragmatic. Whatever works is fine with us. We don't have people saying 'My way is the only way.'"

A follow-up study of using hypnosis for breast surgery is in the planning stages.

-- David Tenenbaum

Bibliography
Adjunctive Non-pharmacological Analgesia for Invasive Medical Procedures: A Randomised Trial, Elvis Lang et al, Lancet, 29 April 2000, pp. 1486-90.