Trial Report Preoperative Hypnosis versus Mindfulness for Reducing Postoperative symptoms in Breast Surgery: A Randomized Clinical Trial, 2025, Reme et al

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Preoperative Hypnosis versus Mindfulness for Reducing Postoperative symptoms in Breast Surgery: A Randomized Clinical Trial

Spoiler: Authors

Reme, Silje E.; Munk, Alice; Montgomery, Guy H.; Schnur, Julie B.; Falk, Ragnhild; Smits, Martijn; Jacobsen, Henrik B.

Abstract
Background:
Breast cancer surgery is often associated with unpleasant postoperative symptoms, including pain, nausea, fatigue, and emotional distress, which can reduce quality of life and prolong recovery times. This study aimed to test the efficacy of preoperative hypnosis in reducing postoperative symptoms following breast cancer surgery.

Methods:
A total of 203 women scheduled for breast cancer surgery at Oslo University Hospital, Norway, participated in a randomized controlled trial. Patients were randomized to receive either a single session of preoperative hypnosis or of mindfulness within two hours prior to their scheduled surgery.

Primary outcomes were postoperative pain, fatigue, nausea, discomfort, and emotional distress, measured using 100mm visual analogue scales on the day of surgery following recovery from general anesthesia.

Additional measures included amount of intraoperative and postoperative anesthesia and analgesia, as well as surgery duration (extracted from patients' medical records).

Results:
Patients receiving preoperative hypnosis reported significantly lower postoperative fatigue (mean difference (MD) 6.4, 95% CI 0.40 – 12.4, Cohen’s d=0.30) and emotional distress (MD 5.7, 95% CI 0.24 – 11.2, d=0.24) when compared to patients in a mindfulness control group.

There was also a significant reduction in postoperative fentanyl use among those patients receiving preoperative hypnosis (MD -0.03, 95% CI -0.047 – -0.005, d=0.54).

Preoperative anxiety moderated the effect of hypnosis on postoperative emotional distress, showing a more pronounced benefit for patients with high levels of preoperative anxiety.

However, no significant differences were found in postoperative pain, nausea, or discomfort between the hypnosis and mindfulness groups.

No adverse events attributed to the interventions were reported.

Conclusions:
A brief preoperative hypnosis session before breast cancer surgery appears to be more effective than mindfulness in reducing postoperative fatigue, emotional distress, and fentanyl dose. Hypnosis stands out as a promising, non-pharmacological, and safe intervention for reducing certain postoperative symptoms.

Web | DOI | Anesthesiology

 

[Utsikt]

It’s touted as a success in the media and they are hoping to provide it to everyone within a year.

Placebo is described by Reme as a «real biological effect», the same with hypnosis.

The Cancer Association is thrilled and proud of having funded the study.

- Om det var en pille, så ville alle tatt den

Neste år skal en stor pasientgruppe få tilbud om hypnose. Slik fungerer det.

www.tv2.no

 

[Utsikt]

The hypnosis was a 15 minute therapist guided session.

The core components involve a relaxation-based induction, suggestions for pleasant imagery, prompts to experience relaxation and peace, and specific symptom-focused suggestions. The suggestions included both suggestions for reduced experience of unpleasant sensations (e.g., reduced pain, reduced nausea, reduced fatigue), and increased experience of pleasant sensations (e.g., increased energy to address fatigue, and relaxation and calm to counter distress).

The mindfullness was to give the participants a headset for listening to a pre-recorded session focused on breathing.

They claim that these were equal, even though they are clearly not. One is telling the participants that they do and will feel less pain, fatigue, etc. The other is not even bothering speaking to them.

 

[forestglip]

They claim that these were equal, even though they are clearly not.

What do you mean by them claiming they are equal? Aren't they claiming they are not equal based on their results?

 

[Utsikt]

What do you mean by them claiming they are equal? Aren't they claiming they are not equal based on their results?

That the mindfulness is an active intervention and that any difference must be due to the unique components of hypnosis.

But if one person gets to talk to a reassuring therapist and the other one gets an audiofile and a headset, the talking to a therapist part might explain the difference.

They should have used mindfulness therapists that would also assure the patients that the exercises would help them feel less pain, fatigue etc. afterwards.

 

[Utsikt]

They defined the MCID as 10 points on a 0-100 VAS. The measurements were done 30 minutes after waking up.

An effect size ≥0.2 has been described as clinically meaningful 31 32, although it is also argued that a 10-point shift on the scale indicates a clinically significant improvement in pain, and a Visual Analog Scale (VAS) score of 33 or lower is considered indicative of satisfactory pain management following surgery 33.

If the pain scores are low in general, the effect size will be large even though the absolute value of the difference is tiny.

Only two reached statistical significance, and none of them were anywhere near 10 points:

Patients receiving preoperative hypnosis reported significantly lower postoperative fatigue (mean difference (MD) 6.4, 95% CI 0.40 – 12.4, Cohen’s d=0.30) and emotional distress (MD 5.7, 95% CI 0.24 – 11.2, d=0.24) when compared to patients in a mindfulness control group.

Postoperative opioid consumption – limited to fentanyl, codeine, oxycodone and tramadol - was converted to morphine milligram equivalents (MME) using conversion ratios from Engel et al 34, the most recent and comprehensive overview of opioids prescribed in Norway. MME values were calculated by multiplying the total opioid dose in milligrams by the respective conversion factor.

They don’t report the data on codeine and oxycodone, other than saying that the differences weren’t statistically significant. They make a point out of the hypnosis group using a bit less fentanyl, but without knowing if the mindfullness group used something else instead, the fentanyl data is kind of useless.

Patients who received preoperative hypnosis used significantly less postoperative fentanyl than patients in the mindfulness control group, consistent with a medium effect size (MD=- 0.03mg, 95% CI [-0.05-0.01], p=0.02, d=0.54, Table 2)

The total MME is the most relevant data here, but they don’t report any p-values. It’s also unclear what would be a meaningful difference.

In the postoperative period, opioid consumption expressed in MME showed that patients in the hypnosis group (n=73/100) received an average of 31.8 ± 22.7 MME, compared with 37.4 ± 32.6 MME the mindfulness group (n=63/100).

The patchy analgesic data, minuscule differences is VAS, lack of long term follow up for VAS, and differences in the delivery mechanisms of the interventions make it difficult to argue that hypnosis is better than mindfulness.