Efficacy of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting: A Randomized Controlled Trial of Integrative Social Work Interventions

Background: Half of inpatients endorse acute pain during hospitalization. Poorly managed acute pain can lead to increased hospitalization costs, reduced patient satisfaction, and risk of persistent pain. Opioids are commonly used to manage acute pain during hospitalization, but opioid-related adverse events are common, and opioid receipt in the hospital is associated with a nearly fivefold increase in the odds of chronic opioid use 12 months after discharge. Adverse effects associated with opioid use underscore the need for non-pharmacological interventions for pain management. Basic neuroscience linking negative emotions to pain perception provides a mechanistic basis for the efficacy of psychosocial pain interventions. As such, social workers may provide psychosocial support to allay pain in the hospital setting. The present study examined the impact of three brief psychosocial interventions provided by hospital social workers: mindfulness training, hypnotic suggestion, and psychoeducation. We hypothesized that a single session of mindfulness or hypnotic suggestion would significantly reduce pain intensity and unpleasantness compared to a psychoeducation control condition. We also hypothesized that mindfulness and suggestion would produce significant increases in relaxation and pleasant body sensations, and reduce anxiety and desire for opioids, compared to the control condition.

Methods: Patients with unmanageable pain during a hospital stay (N = 244) were randomized to receive one of three scripted, 15-minute interventions delivered by hospital social workers: a) pain coping education (n=85), b) mindfulness training (n=86), or c) hypnotic suggestion (n=73). The mindfulness intervention incorporated principles of intentionally paying non-judgmental attention to present-moment experience, with focused attention on breath sensations and an emphasis on pain acceptance. The hypnotic suggestion intervention incorporated imagery and suggestions for changes in cognition, emotion, and body sensations (e.g., imagine changing pain sensations to a comfortable warmth or coolness). The psychoeducation session involved discussion of behavioral coping strategies for pain management.  Primary outcomes were assessed before and after the 15-minute interventions, using validated measures for pain intensity and unpleasantness.  Secondary outcomes included desire for opioids, relaxation, and pleasant body sensations.

Results: Participants in the mind-body interventions reported significantly lower baseline adjusted pain intensity at post-intervention than those assigned to the education condition (p<.001, pain reduction in mindfulness = 23%, hypnosis = 28%, education = 9%), and significantly lower baseline adjusted pain unpleasantness (p<.001). Intervention conditions significantly differed with regard to relaxation (p<.001), pleasurable body sensations (p=.001), and desire for opioids (p<.015), whereas all three interventions were associated with a significant decrease in anxiety (p<.001).

Conclusion and Implications: Brief mind-body interventions delivered by hospital social workers led to significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management and might provide a viable non-pharmacological alternative to opioids. Our study also strongly suggests that in order to meet the Grand Challenge of “closing the health gap,” the role of clinical social workers needs to be expanded to include the provision of these simple-to-deliver, brief mind-body intervention sessions as part of standard medical treatment in healthcare settings where pain management is a priority.