Lang 2000: self-hypnosis during invasive procedures

Lang EV, Benotsch EG, Fick LJ, Lutgendorf S, Berbaum ML, Berbaum KS, Logan H, Spiegel D. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. The Lancet. 2000;355(9214):1486–1490. DOI 10.1016/S0140-6736(00)02162-0.

This trial is a landmark in the procedural-anxiety pile.

Key evidence

241 patients undergoing percutaneous vascular or renal procedures were randomised to intraoperative standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). Everyone could use patient-controlled intravenous fentanyl and midazolam. Pain and anxiety were rated 0–10 before, every 15 minutes during, and after the procedure.

Pain increased with time in standard care (slope 0.09 per 15 minutes) and attention (0.04), and stayed flat under hypnosis. Anxiety decreased in all three groups; the hypnosis slope was steepest (−0.11). Mean drug units were 1.9 (standard), 0.8 (attention), and 0.9 (hypnosis). Haemodynamic instability occurred in 12 standard, 10 attention, and 1 hypnosis patient. Mean procedure time was 78 minutes (standard), 67 (attention), and 61 (hypnosis).

The attention arm matters: some benefit is from a person staying with the patient. Hypnosis still added pain flattening, stability, and time.

Limitations

One centre, one procedure class, one session. Spiegel is a co-author; allegiance is a real modifier, which is why Schnur’s wider RCT pile sits beside this paper.

What we don't know yet

Whether the same script helps a person with GAD in a weekly clinic chair is not what Lang randomised.

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