THE USE OF HYPNOTIC TECHNIQUES
TO REDUCE THE USE OF ANALGESICS FOR DENTAL SURGERY.
By C. Devin Hastings
 

Please note that this article is a summary of a report written by Bjorn Enqvist of Eastman Dental Center and Karolinska Institute, Stockholm Sweden and of work done by Kerstin Fischer of Falu Hospital, Falun, Sweden. Complete report reprints can be requested from Bjorn Enqvist, D.D.S., Eastmaninstitutet, Dalagatan 11, 113 24 Stockholm, Sweden.

AIM: The purpose of the following study was to investigate whether preoperative hypnosis techniques can reduce stress and improve healing and patient recovery from dental surgery.

ABSTRACT: This study was designed to evaluate the effectiveness of hypnosis techniques used prior to dental surgery. Two groups of patients were assigned. One was the experimental group in which hypnosis was utilized and the second was a control group which received no hypnosis coaching. The experimental group listened to an audio hypnosis program containing a relaxation induction. Also included on the audio program were posthypnotic suggestions for healing and recovery. Suggestions were also given regarding ways to achieve control over stress and pain. One surgeon was assigned to all 69 patients in the study. 36 were in the control (non-hypnotic) group and 33 received the benefits of hypnosis motivational coaching (the experimental group). Anxiety increased significantly in the control group while those who listened to the audio program maintained their initial baseline levels of calm. Post-operative intake of pain-killers was significantly less in the experimental group as compared to the control group.

A fascinating aspect of this study is that a number of controlled studies have been cited stating that hypnotic techniques have reduced bleeding associated with tooth extractions in hemophiliacs. (1)

Also of interest is that two more Swedish studies have found that the use of hypnosis prior to dental surgery revealed a significant decrease in bleeding postoperative facial swelling (2). It was also noted that less time was needed for recuperation in the hospital where the surgery was performed (3). What is of compelling interest is that these patients received no personal hypnosis training but instead, only listened to a preoperative hypnosis audio program.

STUDY GROUP AND METHODS: The 36 control group patients were slightly older (M = 28.5 years, SD = 5.35) than the experimental group patients (M = 27.7 years, SD 6.23). 19 men and 17 women participated in the control group while 14 men and 19 women were in the experimental group.

After an initial exam, the experimental group received an envelope with information, instructions and a hypnosis tape. The control group also received an envelope with identical contents except they received no hypnosis tape. Patients were randomly assigned to each group by a non-biased distribution of the envelopes. Neither the surgeon nor the assisting personnel were aware of group assignments.

The audio tape was a 20 minute program containing the following 6 elements:
1) A mental and physical hypnotic relaxation induction.
2) Suggestions for the inner creation of a safe place.
3) Suggestions to positively influence unconscious knowledge of how to control bleeding, coagulation and healing.
4) Pain relief methods utilizing dissociation and direct suggestions.
5) Instructions on creating a personal way to create and experience a relaxed state of being. Calming words, pictures and/or breath control were suggested.
6) A 120 second segment of soft music accompanied by suggestions was used at the end of the session to help a patient to return to a ‘normal’ state of mind.

The experimental group patients were instructed to listen to the tape daily before surgery. In the event of unexpected reactions, the patients were given the phone number of the hypnotherapist who created the audio session. 2 patients were excluded from the study because they listened to the tape 1 or fewer times. The other patients in the study listened to the hypnosis program at least three times.


RESULTS: As previously stated, anxiety in the preoperative control group increased significantly between initial surgery registration and the day of surgery. The experimental group reported no increase in anxiety.

The pain-killer used was Citodon (Pharcetamol-Codeinphosp). In the control group, 28% of the patients consumed three or more equipotent doses of the analgesic whereas only 3% of the experimental group consumed three or more equipotent doses.

There was no difference in the experience of pain by both groups though again, it must be noted that analgesic consumption was much less in the experimental group.

It must be noted that in order for this study to be statistically valid, a larger number of participants is needed to see differences in other factors.

SUMMARY: One can draw the conclusion that there is a great deal of thought provoking, credible information gleaned from these studies that shows hypnosis to be quite useful for those facing surgery.
 

REFERENCES:
(1) Lucas, O.M. (1962) Dental extraction in hemophiliac: Control over emotional factors by hypnosis. American Journal of Clinical Hypnosis, 7, 301-307.
(2) Enqvist, B., von Konow, L., & Bystedt, H. (1995a). Pre- and perioperative suggestion in maxillo-facial surgery: Effects on blood loss and recovery. International Journal of Clinical and Experimental Hypnosis, 43, 284-294
(3) Enqvist, B., von Konow, L., & Bystedt, H. (1995b). Stress reduction, preoperative hypnosis and perioperative suggestion in maxillo-facial surgery. Stress Medicine, 11, 229-233