Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting

Abstract

Background: Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.

Objective: We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.

Methods: This three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting "intolerable pain" or "inadequate pain control." Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).

Key results: Participants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).

Conclusions: Brief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.

Trial registration: Trial Registry: ClinicalTrials.gov ; registration ID number: NCT02590029 URL: https://clinicaltrials.gov/ct2/show/NCT02590029.

Keywords: acute pain; analgesia; hypnosis; mindfulness; non-opioid therapy; opioid.

Figure 1

CONSORT Flow Diagram of the Randomized Clinical Trial of Mindfulness, Suggestion, and Education for Acute Inpatient Pain. *Reasons for exclusion were as follows: patient had a cognitive impairment, was discharged before study assessment and intervention could be initiated, was unavailable or uncooperative, was under age 18, had a language barrier, was a prisoner, denied experiencing pain at the time of the intervention, was intubated, or had a hearing impairment.

Figure 2

Numeric rating scale (NRS) pain intensity ratings (± 95% confidence intervals). Participants assigned to mindfulness (p = 0.001) and hypnotic suggestion (p < 0.001) reported significantly lower baseline-adjusted pain intensity ratings post-intervention compared with a psychoeducation control condition. Within-subject pain intensity reduction: * p < 0.05, ** p < 0.01, *** p < 0.001.

Figure 3

Numeric rating scale (NRS) pain unpleasantness ratings (± 95% confidence intervals). Participants assigned to mindfulness (p < 0.001) and hypnotic suggestion (p < 0.001) reported significantly lower baseline-adjusted pain unpleasantness ratings post-intervention compared with a psychoeducation control condition. Within-subject pain unpleasantness reduction: * p < 0.05, ** p < 0.01, *** p < 0.001.