Randomized Controlled Trial of Brief Hypnotic Suggestion and Mindfulness Training for Preoperative Pain and Anxiety

Background: Preparing for elective, orthopedic surgery can be challenging for patients. Specifically, preoperative patients must cope with the physical pain occasioning the surgery. Additionally, preoperative patients mush also cope with any psychological distress elicited by their impending medical procedure. Together, preoperative pain and psychological distress may create a positive feedback loop amplifying both forms of discomfort. Patients’ preoperative psychological state has been shown to be a valuable predictor of postoperative outcomes, with positive psychological coping skills portending better results. Thus, equipping preoperative patients with evidence-based coping skills may have a dual effect by: a) reducing preoperative physical pain and psychological distress, and b) improving postoperative outcomes and thereby reducing the likelihood of opioid misuse and addiction.

Mind-body interventions have been shown to be efficacious in reducing both physical pain and psychological distress. Two common mind-body interventions are hypnosis and mindfulness. Hypnosis is an altered state of consciousness characterized by focused attention and reduced peripheral awareness. Mindfulness is a metacognitive state in which thoughts, feelings and sensations are experienced nonjudgmentally. A recent randomized control trial revealed that a single, scripted session of hypnotic suggestion and mindfulness training effectively reduced pain, and desire for pain medication in a sample of hospital inpatients, relative to psychoeducation. Given these promising findings, we sought to replicate this design in an outpatient population preparing for elective, hip or knee orthopedic surgery.

Methods: This study was a three-arm, randomized controlled trial conducted at a university-based orthopedic clinic during a preoperative information session for patients scheduled for surgery. Patients (N = 92) were assigned to one of three, 15-minute psychosocial intervention conditions delivered by either a social worker or a psychologist: mindfulness (n = 33), hypnotic suggestion (n = 28), or psychoeducation (n = 31). Patients completed a brief survey measuring pain, desire for pain medication, and anxiety pre- and post-intervention. Change scores were calculated by subtracting the post-intervention score from the pre-intervention score for each variable.

Results: Repeated measures ANOVA with Bonferroni post hoc analysis revealed a pattern of significantly reduced pain (F_2,92=3.61, p=.03), desire for pain medication (F_2,92=2.86, p= .05), and anxiety (F_2,93=3.06, p=.05) for participants receiving mind-body interventions compared with psychoeducation. Results indicated the mind-body interventions did not differ in their effectiveness. Bivariate correlations indicated that, regardless of condition, decreased pain was associated with decreased desire for pain medication (r=.32, p=.002) and decreased anxiety (r=.22, p=.03). Similarly, decreased anxiety was associated with decreased desire for pain medication (r=.32, p=.001).

Conclusions and Implications: Findings from this study indicate that a brief mind-body intervention, conducted by a social worker, is likely to alleviate pain, decrease medication desire, and relieve anxiety in patients preparing for elective, orthopedic surgery. In this sample, hypnotic suggestion and mindfulness training encouraged more positive changes than psychoeducation. As such, mind-body interventions may be useful adjuncts to medical pain management, and the identification of effective, non-pharmacological pain management strategies is imperative in the context of the opioid crisis.