title: Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial.
abstract: BACKGROUND
  Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures. We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospective, randomised, single-centre study.
  
  
  METHODS
  241 patients were randomised to receive intraoperatively standard care (n=79), structured attention (n=80), or self-hypnotic relaxation (n=82). All had access to patient-controlled intravenous analgesia with fentanyl and midazolam. Patients rated their pain and anxiety on 0-10 scales before, every 15 min during and after the procedures.
  
  
  RESULTS
  Pain increased linearly with procedure time in the standard group (slope 0.09 in pain score/15 min, p<0.0001), and the attention group (slope 0.04/15 min; p=0.0425), but remained flat in the hypnosis group. Anxiety decreased over time in all three groups with slopes of -0.04 (standard), -0.07 (attention), and -0.11 (hypnosis). Drug use in the standard group (1.9 units) was significantly higher than in the attention and hypnosis groups (0.8 and 0.9 units, respectively). One hypnosis patient became haemodynamically unstable compared with ten attention patients (p=0.0041), and 12 standard patients (p=0.0009). Procedure times were significantly shorter in the hypnosis group (61 min) than in the standard group (78 min, p=0.0016) with procedure duration of the attention group in between (67 min).
  
  
  CONCLUSIONS
  Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures. Hypnosis had more pronounced effects on pain and anxiety reduction, and is superior, in that it also improves haemodynamic stability.
authors.affiliation: Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Radiology, Boston, MA 02215, USA. elang@caregroup.harvard.edu
authors.forename: E V
authors.initials: EV
authors.lastname: Lang
authors.forename: E G
authors.initials: EG
authors.lastname: Benotsch
authors.forename: L J
authors.initials: LJ
authors.lastname: Fick
authors.forename: S
authors.initials: S
authors.lastname: Lutgendorf
authors.forename: M L
authors.initials: ML
authors.lastname: Berbaum
authors.forename: K S
authors.initials: KS
authors.lastname: Berbaum
authors.forename: H
authors.initials: H
authors.lastname: Logan
authors.forename: D
authors.initials: D
authors.lastname: Spiegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000704:Analysis of Variance; D001007:Anxiety; D001288:Attention; D004194:Disease / Q000145:classification; D005260:Female; D006801:Humans; D006990:Hypnosis; D008297:Male; D008875:Middle Aged; D010146:Pain; D010147:Pain Measurement; D012064:Relaxation Therapy; D013514:Surgical Procedures, Operative