The effectiveness of hypnotic analgesia in the management of procedural pain in minimally invasive procedures: A systematic review and meta‐analysis

Abstract

Introduction Patients undergoing minimally invasive procedures under a light conscious sedation perceive pain and anxiety. Hypnosis used together with analgesics has been investigated in numerous studies. Aims and methods To assess the effectiveness of hypnotic analgesia in management of pain, anxiety, analgesic consumption, procedure length and adverse events in adults undergoing minimally invasive procedures. Clinical controlled trials in which hypnosis was used together with pharmacological analgesia compared to pharmacological analgesia alone during invasive procedures were included. Seven databases were searched. The methodological quality of the studies was assessed by two reviewers using a standardised instrument for critical appraisal from Joanna Briggs Institute, ‘Meta‐Analysis of statistics assessment and review Instrument’. Meta‐analyses using the review manager version 5.3 software were conducted on procedure length and adverse events. Results for pain, anxiety and analgesics were synthesised in narrative summaries. Conduction of the review adheres to the PRISMA checklist. Results Ten studies comprising 1,365 participants were included. A reduction in the consumption of pain medication was found between 21%–86% without aggravating pain intensity and anxiety. In few studies, significant reduction in pain intensity and anxiety was found. Meta‐analysis including seven studies revealed a small beneficial effect on reducing procedure length. A meta‐analysis on adverse events showed no significant reduction. Statistical heterogeneity was found among the studies included. Conclusion For patients undergoing invasive procedures, hypnotic analgesia was effective in reducing consumption of analgesics. Only a slight effect was, however, found on experienced anxiety and pain intensity. It did not prolong the procedure and was safe to provide. Relevance to clinical practice Hypnosis is recommended as pain management for adults during invasive procedures. A reduced consumption of pain medication potentially has a major impact on monitoring and observation of patients following the procedure, thus improving patient safety and reducing resource consumption.

Hypnosis for Clinical Pain Management: A Scoping Review of Systematic Reviews

“…We did not identify any new articles with our second search performed on December 31, 2019. Thus, we included a total of 13 systematic reviews or meta-analyses that synthesized results from 99 RCTs or non-randomized clinical trials published from 1841 to 2017 that evaluated the effects of hypnosis on pain [15][16][17][18][28][29][30][31][32][33][34][35][36]. There were overlapping trials between reviews: overall, there were 77 unique trials that included data from more than 6,882 participants (one review did not report sample sizes [33]).…”

“…Five of the reviews summarized in this paper reviewed the effects of hypnosis on procedural pain [18,28,29,34,35], four reviewed studies examining the effects of hypnosis on chronic pain [16,32,33,36], and four reviewed trials that examined the effects of hypnosis on other pain conditions [15,17,30,31]. However, the authors of one of the reviews that sought to evaluate the effects of hypnosis on end-of-life cancer pain were unable to find any trials to review that met their inclusion criteria [31].…”

“…Based on the information provided in the thirteen reviews, thirty-eight trials examined the effects of self-hypnosis using audio recordings, most often (but not always) after one or more face-to-face hypnosis sessions [15-17, 28, 29, 33, 35, 36]. Five unique trials included in three reviews used audio recordings to teach hypnosis without any face-to-face sessions [17,18,35]. Although most trials provided hypnosis treatment to individual patients, the reviewers also reported on some trials that used group therapy for teaching hypnosis [15,29,36].…”

“…There were also large differences in the dose (e.g., number and length of sessions) of hypnosis and who provided the hypnotic interventions. Three reviews did not provide any information regarding the dose used in the trials reviewed [28,30,33], and only seven reviewers provided some information regarding who provided the hypnosis treatment, including the level of expertise of the clinicians [15,[28][29][30][34][35][36]. Only one review reported on the training and experience of the treatment deliverer [35].…”

“…The frequency of hypnosis sessions ranged from just one session (most often in studies evaluating the effects of hypnosis for medical procedure-related pain; [17,18,[34][35][36] to as many as fourteen sessions for treatment of chronic conditions such as fibromyalgia [32] and forty-eight sessions for ongoing breast cancer care [29]. A similar variation was also seen in the duration of individual sessions, which varied from 10 minutes [18,35] to 2 hours [32]. Hypnosis interventions were delivered in the trials by psychologists, hypnotherapists, nurses, medical students, physicians, research assistants and psychotherapists.…”