Health briefings September 12, 2005
You won’t feel a thing . . .
by Liz Bestic
Hypnosedation may reduce the need for general anaesthetic How amusing it is to see hypnotists make people cluck like chickens or bark like dogs. But while their art is seen by many as a form of entertainment, new research suggests that, medically, there may be a serious role for hypnosis. Using functional magnetic resonance imaging (fMRI) a team of neuroscientists at the University of Pittsburgh have seen hypnosis actually working on the brain. In a study to be published this year, a group of patients with the painful rheumatic condition fibromyalgia were hypnotised to imagine a dial controlling their pain levels.
As Professor Stuart Derbyshire, of the University of Birmingham, who led the study, says: “We asked them to turn the dial up or down and watched what happened on the scan.” As the pain was “turned up”, it registered in those areas in the brain dealing with pain. During hypnosis patients enter a trance-like state in which the conscious mind is bypassed. A common approach is to use music to soothe patients, then to talk them through memories of a favourite place; all other information is blocked out.
Such an approach obviates the need for general anaesthetic, and so may reduce bleeding, postoperative recovery time, as well as potential side-effects of anaesthesia. When Kathleen Duff, a former nurse, had a cystoscopy she opted for hypnosedation, having tried it for a minor hand operation. “I felt absolutely nothing when they put the camera into my bladder. I had very little bleeding, and none of that muzzy feeling you get after an anaesthetic.”
Dr David Rogerson, a consultant anaesthetist at Derby City General Hospital, uses hypnosis during orthopaedic operations such as hip replacements. “Only two out of a hundred of my patients have any additional chemical sedation” that means they are less at risk of aspirating stomach contents into their chest which can result in aspiration pneumonia. Anaesthetists at the Liege Hospital, Belgium, have use hypnosedation for more than a decade in more than 4,800 operations.
Research there shows that patients undergoing thyroid surgery who had hypnosedation needed less pain relief during surgery than those who had general anaesthesia and were able to return to work within ten days, compared with an average of 36 for anaesthetised patients. Dr Jean Joris, a consultant anaesthetist, says the technique not only improves recovery time, but also reduces bleeding and inflammation. “When patients are hypnotised they are more relaxed, which causes dilation of the blood vessels so that bleeding decreases.”
Dr Dirk Hermes, an oral and maxillofacial surgeon at University Hospital, Germany, uses hypnosis in combination with local anaesthesia. He says hypnosedation can be useful for patients who have had a bad experience with general anaesthesia. One such patient was told to imagine he was on a beach. “After the operation he said the day had been lovely, but that he’d got terrible sunburn. We’d cut away half his face and that was his only experience of the pain. We can tell when patients are under by the horizontal eye movements and decrease in the heart rate and blood pressure. The face muscles also relax. When we want them to come out of the trance we ask them to move their hand or foot gently and they gradually relocate themselves.”
Hypnosedation has yet to take off in the UK. Dr Rumi Peynovska, the secretary of the British Association of Medical Hypnosis blames this partly on funding, adding: “Putting patients in a trance takes time; the way the NHS is structured does not allow for this.” Professor David Hatch, of the Royal College of Anaesthetists, agrees that time is a factor. “There is also widespread acceptancethat general anaesthesia is very safe. Most anaesthetists would not be opposed to hypnosedation; it’s very safe.”
British Association of Medical Hypnosis bamh.org.uk British Society of Clinical Hypnosis, bsch.org.uk