Effects of perioperative clinical hypnosis on heart rate variability in patients undergoing oncologic surgery: secondary outcomes of a randomized controlled trial

Muhammad Abid Azam; Aliza Z Weinrib; P Maxwell Slepian; Brittany N Rosenbloom; Anna Waisman; Hance Clarke; Joel Katz

doi:10.3389/fpain.2024.1354015

Effects of perioperative clinical hypnosis on heart rate variability in patients undergoing oncologic surgery: secondary outcomes of a randomized controlled trial

Front Pain Res (Lausanne). 2024 Mar 8:5:1354015. doi: 10.3389/fpain.2024.1354015. eCollection 2024.

Authors

Muhammad Abid Azam^{1

2}, Aliza Z Weinrib^{1

2}, P Maxwell Slepian^{1

2

3}, Brittany N Rosenbloom⁴, Anna Waisman¹, Hance Clarke^{2

3}, Joel Katz^{1

2

3}

Affiliations

¹ Department of Psychology, York University, Toronto, ON, Canada.
² Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada.
³ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto ON, Canada.
⁴ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.

Abstract

Introduction: Clinical hypnosis has been proposed for post-surgical pain management for its potential vagal-mediated anti-inflammatory properties. Evidence is needed to understand its effectiveness for post-surgical recovery. Iin this secondary outcome study, it was hypothesized that surgical oncology patients randomized to receive perioperative clinical hypnosis (CH) would demonstrate greater heart-rate variability (HRV) during rest and relaxation at a 1-month post-surgery assessment compared to a treatment-as-usual group (TAU).

Methods: After REB approval, trial registration and informed consent, 92 participants were randomized to receive CH (n = 45) or TAU (n = 47). CH participants received a CH session before surgery and during post-surgical in-hospital stay HRV was assessed during rest (5 min) and relaxation (10 min) before and 1-month after surgery. Pain intensity was obtained using a 0-10 numeric rating scale pre and post 1-week and 1-month post surgery.

Results: One month after surgery, HRV was significantly higher in CH group (n = 29) during rest and relaxation (both p < 0.05, d = 0.73) than TAU group (n = 28). By contrast, rest and relaxation HRV decreased from pre- to 1-month post-surgery for the TAU (both p < 0.001, d > 0.48) but not the CH group. Pain intensity increased from pre-surgery to 1-week post-surgery (p < 0.001, d = 0.50), and decreased from 1-week to 1-month post-surgery (p = 0.005, d = 0.21) for all participants.

Discussion: The results suggest that hypnosis prevents the deleterious effects of surgery on HRV by preserving pre-operative vagal activity. These findings underscore the potential of clinical hypnosis in mitigating the adverse effects of surgery on autonomic function and may have significant implications for enhancing post-surgical recovery and pain management strategies.

Clinical trial registration: ClinicalTrials.gov, identifier (NCT03730350).

Keywords: clinical hypnosis; high frequency heart rate variability; oncologic surgery; postoperative opioid use; postoperative pain.

Associated data

ClinicalTrials.gov/NCT03730350