Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results

Abstract

Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain ( P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group ( P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.

Hypnosis Sedation Reduces the Duration of Different Side Effects of Cancer Treatments in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

“…The modalities and the course of the procedure were extensively described to patients. In this study, no patient requesting hypnosis sedation was refused [1,2].…”

“…In our institution, all patients were evaluated for acute pain during the postoperative period in an attempt to adequately treat acute postoperative pain and avoid chronicization of pain [2]. Evaluations were performed by Numerical Pain Rating Scales and Visual Analog Scales on day 0, day 1 and day 8; thereafter, such as for polyneuropathy, musculoskeletal pain and cancer-related fatigue, monitoring was assessed during oncologic follow-up: every 3 months during the first 2 years after the surgical step.…”

“…Side effects of anticancer treatments exert deleterious effects on quality of life. As an increasing number of patients are surviving breast cancer, it is of major importance to preserve the best quality of life and thus to reduce therapy-induced side effects [1,2]. In this study, we focused on the early and late long-term symptoms after neoadjuvant chemotherapy.…”

“…It concerns pain located in the surgical area: breast in case of conservative approach, chest wall in case of mastectomy, shoulder and arm. The perioperative period appears as a key time point to prevent the development of chronic pain after the classical period of postoperative pain [2]. Persistent pain following treatment of breast cancer is a common occurrence affecting 25 to 60% of patients and has been linked to decreased quality of life [11][12][13][14][15].…”

What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer

“…Of particular relevance here are effects that involve pain reduction, reduced need for medication, and shorter duration of surgery, with effect sizes indicating better clinical outcomes in patients receiving hypnosis than 89% of patients in control groups ( Montgomery et al, 2002 ). Hypnosis has further been shown to be superior to other psychological techniques (e.g., therapeutic suggestions; Kekecs et al, 2014 ) and might also provide benefits when delivered during general anesthesia ( Berlière et al, 2018 ; Lacroix et al, 2019 ; Nowak et al, 2020 ). While studies of long-term effects of hypnosis are scarce, one recent study indicates the potential for preventing CPSP with peri-operative hypnosis ( Berlière et al, 2018 ) in line with the SURGE model of CPSP.…”