Self-hypnosis before gynecologic surgery can reduce patients’ anxiety levels but does not seem to impact post-operative recovery, according to results of the HERO-Trial.

Including self-hypnosis as part of an enhanced recovery after surgery (ERAS) pathway proved feasible and produced high levels of patient satisfaction but did not significantly impact pain or opioid intake after surgery.

These results were presented at the SGO 2022 Annual Meeting on Women’s Cancer by Larissa Meyer, MD, of the University of Texas MD Anderson Cancer Center.

Dr Meyer explained that ERAS is a patient-centered, evidence-based, multidisciplinary care pathway intended to reduce the surgical stress response, optimize physiologic function, and facilitate recovery.

Self-hypnosis uses strategies like deep breathing and guided imagery to induce patients into a relaxed state that may include feelings of dissociation. Prior research has shown that self-hypnosis can reduce patient distress before surgery and decrease postoperative pain and anxiety.

Dr Meyer and colleagues tested self-hypnosis as part of an ERAS pathway in 138 patients who underwent open gynecologic surgery.

Patients were randomly assigned to either the standard ERAS (67 patients) or ERAS plus self-hypnosis (71 patients) with a 20-minute audio recording based on a well-validated medical hypnosis script. Patients assigned to self-hypnosis were asked to listen to the audio file at least twice before surgery.

The study’s primary objective was to evaluate the feasibility of self-hypnosis and determine if the intervention could improve patients’ perception of post-surgical pain. The primary efficacy outcome was worst pain on post-operative day 1. Other outcomes included anxiety, satisfaction, and opioid use.

Results

The majority (77.5%) of patients assigned to the self-hypnosis arm were able to listen to the audio file in the preoperative holding unit. However, the study was stopped early due to futility in achieving the primary efficacy outcome.

There were no significant differences in the outcome of worst pain on post-operative day 1. The median worst pain score was a 6 out of 10 in the standard arm and a 7 out of 10 in the self-hypnosis arm (P =.70).

Additionally, there were no significant differences between the arms for the following outcomes:

• Highest pain score — 5 out of 10 in both arms (P =.43)
• Median length of stay — 3 days in both arms (P =.09)
• Median preoperative anxiety score — 4 out of 10 in both arms (P =.09)
• Median morphine-equivalent daily dose on post-operative day 1 — 11 mg in the standard arm and 15 mg in the self-hypnosis arm (P =.22).

However, among patients assigned to self-hypnosis, anxiety scores decreased significantly after the intervention (P <.001). Furthermore, patient satisfaction with the intervention was high (median score, 8/10). Patients generally found the intervention useful (median score, 8/10) and said they would use self-hypnosis again (median score, 9/10).

“Given the ease of accessing and listening to an audio file, this self-hypnosis intervention could be easily integrated into perioperative care to decrease perioperative anxiety,” Dr Meyer said.

Disclosures: This research was partly supported by Pacira Pharmaceuticals, Inc. Dr Meyer disclosed relationships with AstraZeneca, GlaxoSmithKline, CRISPR Technologies, Invitae, Bristol Myers Squibb, and Johnson & Johnson. 

Read more of Cancer Therapy Advisor’s coverage of SGO 2022 by visiting the conference page.

Reference

Meyer L, Iniesta-Donate M, Munsell M, et al. HERO-Trial: Integration of self-hypnosis in an enhanced recovery after surgery program: A prospective randomized trial. Presented at SGO 2022; March 18-21, 2022. Abstract 115.

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