Beneficial effects of hypnosis and adverse effects of empathic attention during percutaneous tumor treatment: when being nice does not suffice

Abstract

Purpose: To determine how hypnosis and empathic attention during percutaneous tumor treatments affect pain, anxiety, drug use, and adverse events.

Materials and methods: For their tumor embolization or radiofrequency ablation, 201 patients were randomized to receive standard care, empathic attention with defined behaviors displayed by an additional provider, or self-hypnotic relaxation including the defined empathic attention behaviors. All had local anesthesia and access to intravenous medication. Main outcome measures were pain and anxiety assessed every 15 minutes by patient self-report, medication use (with 50 mug fentanyl or 1 mg midazolam counted as one unit), and adverse events, defined as occurrences requiring extra medical attention, including systolic blood pressure fluctuations (> or =50 mm Hg change to >180 mm Hg or <105 mm Hg), vasovagal episodes, cardiac events, and respiratory impairment.

Results: Patients treated with hypnosis experienced significantly less pain and anxiety than those in the standard care and empathy groups at several time intervals and received significantly fewer median drug units (mean, 2.0; interquartile range [IQR], 1-4) than patients in the standard (mean, 3.0; IQR, 1.5-5.0; P = .0147) and empathy groups (mean, 3.50; IQR, 2.0-5.9; P = .0026). Thirty-one of 65 patients (48%) in the empathy group had adverse events, which was significantly more than in the hypnosis group (eight of 66; 12%; P = .0001) and standard care group (18 of 70; 26%; P = .0118).

Conclusions: Procedural hypnosis including empathic attention reduces pain, anxiety, and medication use. Conversely, empathic approaches without hypnosis that provide an external focus of attention and do not enhance patients' self-coping can result in more adverse events. These findings should have major implications in the education of procedural personnel.

Fig. 1a and b

Median Pain Ratings (a) and Median Anxiety Ratings (b) Source data from Table 2 which contains the interquartile ranges and patients remaining at each interval. * indicates a significant difference between hypnosis and standard treatment, and # indicates a significant difference between empathy and hypnosis treatment. Significance level 0.0167. Ischemic changes are anticipated around 50 min of room time.

Fig. 1a and b

Median Pain Ratings (a) and Median Anxiety Ratings (b) Source data from Table 2 which contains the interquartile ranges and patients remaining at each interval. * indicates a significant difference between hypnosis and standard treatment, and # indicates a significant difference between empathy and hypnosis treatment. Significance level 0.0167. Ischemic changes are anticipated around 50 min of room time.