Hypnosis: Magic Trick or the Future of Anesthesia?

By Mike Cooper

Before the first use of ether 150 years ago, drinking whiskey and “biting the bullet” were the only methods of curbing the agonizing pain experienced during surgery.  However, the infamous discovery of ether in 1846 by the dentist, Dr. Thomas Morton, changed everything, and anesthesia has paved the way for pain-free surgery.  Using the skill of carefully applied pharmacology, practitioners of anesthesia provide patients undergoing surgery with a painless experience, and often one that they will not remember.  Dr. Melvin Konner, a physician and anthropologist, eloquently describes anesthesiologists as follows: “[They] are the chemists of human consciousness, the technological arbiters of pain, constantly walking the line between life and death, and leading their patients along it.”1 Because of the high level of responsibility of anesthetists in the operating room, it is imperative that they use the safest and most effective methods of anesthesia available.

If chemical anesthesia remained undiscovered, it is likely hypnosis would take its place as the prevailing method of pain-free surgery.  Because of its checkered history, as well as the discovery of ether and chloroform in the 1840s, the benefits of using hypnosis in the operating room have been overshadowed until fairly recently.  Today, anesthetists are beginning to use hypnosis as an adjunct to chemical anesthesia in order to decrease the amount of drugs required to put patients to sleep, thereby reducing the number of anesthesia-related side effects and complications.  Research has demonstrated that hypnosis provides the patient with a greater feeling of control during the operation, which raises confidence and decreases the fear of having surgery.  Studies have also shown that hypnosis decreases the time it takes to recover from surgery.2 Additionally, the use of hypnosis also ameliorates two serious and potentially fatal complications that can arise from the use of anesthetics alone:  anesthesia awareness and malignant hyperthermia.

During anesthesia awareness, the patient wakes up during surgery but is unable to inform the anesthetist because his or her muscles are paralyzed from the anesthesia.  In his book, Under the Mask, Dr. James E. Cottrell, an anesthesiologist, discusses a case in which a woman wakes up after induction and lives through the nightmare of feeling her ovaries removed during an oophorectomy.3 Currently, the specific cause of anesthesia awareness is unknown, but it may be a result of not giving enough anesthetics.  Malignant hyperthermia is an adverse reaction to anesthesia in which the patient’s temperature rises to fatal heights.  By using hypnosis as an adjunct to chemical anesthesia, the amount of drugs required during surgery can be lowered, thus reducing these two potentially fatal complications, as well as other side effects.

Unlike chemical anesthesia, the history of hypnosis is not filled with any major discoveries that revolutionized the practice of surgery such as ether, chloroform, and nitrous oxide.4 Not only is its history less glamorous, but also hypnosis is commonly misunderstood as a magic trick, a loss of control, or a form of sleep.  This misconception has led to hypnosis being discredited by many physicians and patients.  An accurate definition of hypnosis is given by Dr. Philip D. Shenefelt, Associate Professor of the Department of Internal Medicine at the University of South Florida: “The intentional induction, deepening, maintenance, and termination of the natural trance state for a specific purpose.”5

Interestingly, the use of hypnosis in surgery dates as far back as the use of ether in the late 19th century, when Dr. James Esdaile, a medical officer for the British East Indian Company, successfully performed over 300 major surgeries using hypnosis as the only anesthetic.2 Hypnosis, used properly, can invoke analgesia, amnesia, and muscle relaxation—the same three desired outcomes of chemical anesthesia.  Dr. David Spiegal, Associate Chair of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, believes that being in a state of hypnosis is akin to looking through a telephoto lens:  “What you see you see with great detail, but you’re less aware of the surroundings, of the context in which you’re experiencing it.  So it’s like getting so caught up in a good movie that you forget you’re watching the movie, you enter the imagined world.”6

At the turn of the century, Dr. Elvira Lang at Harvard Medical School and physicians in Belgium separately conducted two important research studies, both of which demonstrated that patients who receive hypnosis in addition to conscious sedation during surgery experience greater pain relief, less anxiety, fewer adverse events, and better postoperative outcomes than patients who receive conscious sedation alone.7 8 Although it is not well understood how hypnosis works physiologically, early studies suggest that its effects may be similar to the anesthetic drug, fentanyl—an increase in activity in the anterior cingulate cortex reduces pain perception primarily by promoting regional cerebral blood flow in the prefrontal cortex.9  As far as cost is concerned, analyses have shown that hypnosis reduces costs both during and after an operation.8

Anesthetists can be trained in hypnosis through continuing education, so there is no need to have an additional “hypnosis practitioner” in the operating room.  The complementary practice of hypnosis and anesthesia is also reimbursable by insurance companies.  By combining hypnosis with chemical anesthesia, patients can feel less fearful entering the operating room, have greater confidence and need less medication during surgery, and have a smoother recovery, all while reducing costs for themselves and hospitals.

References
1. Konner, Melvin. A Journey of Initiation in Medical School. New York:Penguin Books USA, Inc., 1987.
2. Wain, Harold J. Reflections on Hypnotizability and Its Impact on Successful Surgical Hypnosis. April 2004. American Journal of Clinical Hypnosis. 17 Jan. 2012 <http://www.ncbi.nlm.nih.gov/pubmed/15190732&gt;.
3. Cottrell, James E. Under the Mask. New Brunswick, New Jersey: Rutgers University Press, 2001.
4. Fenster, Julie M. Ether Day. New York: HarperCollins Publishers Inc, 2001.
5. Shenefelt, Philip D. Hypnosis: Applications in Dermatology and Dermatologic Surgery. 18 May 2005. eMedicine. 17 Jan. 2012 <http://www.emedicine.com/derm/topic921.htm>.
6. Lurie, Karen. Hypnosis Surgery. 18 Jan. 2005. ScienCentral News. 17 Jan. 2012 <http://www.sciencentral.com/articles/view.php3?article_id=218392458&cat=1_7&gt;.
7. Tenenbaum, David. Hyp, Hyp, Hooray for Hypnosis. 8 Aug. 2000. The Why Files. 17 Jan. 2012 <http://whyfiles.org/shorties/061hypnosis/>.
8. Kihlstrom, John F. The Basics of Hypnosis. 21 Sept. 2000. Institute for the Study of Health Care Organizations and Transactions. 17 Jan. 2012 <http://www.institute-shot.com/hypnosis_and_health.htm>.
9. Under the Knife, Under Hypnosis. 6 Aug. 2005. New Scientist Magazine. 17 Jan. 2012 <http://www.hypnoanalysis.com/articles_undertheknife.html&gt;.

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