Title

Medical hypnosis and orthopedic hand surgery: Pain perception, post-operative recovery, and adherence

Date of Award

1994

Availability

Article

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Counseling Psychology

First Committee Member

Kent Burnett, Committee Chair

Abstract

Orthopedic hand-surgery patients experience severe pain post-operatively, yet they must engage in painful exercises and wound-care shortly after surgery; poor involvement results in complications that may lead to loss of function and/or disfigurement. This study tested a cognitive-behavioral intervention including relaxation, imagery, and therapeutic suggestions (hypnosis) designed to reduce pain perception, enhance post-surgical recovery, and facilitate rehabilitation.Sixty hand-surgery patients at a large urban county hospital were divided into two groups which were randomly assigned to usual-treatment or usual-treatment plus hypnosis. The intervention was administered daily for four days. Outcome measures were: (a) daily self-ratings of patient's perceived pain, suffering, state-anxiety, and comfort during occupational therapy (OT); (b) occupational therapists' ratings of patients' cooperation and observed comfort at two time-points during intervention; (c) surgeons' ratings of treatment progress at two time-points during hospitalization; (d) length of hospitalization; (e) amount of analgesics used; and (f) complications.Significant between-groups differences for perceived pain, suffering, and state-anxiety were found using MANOVA (Hotelling's =.79, exact F(3,43) = 11.30, p =.000). By Day Four, and after controlling for gender, race, and pre-treatment scores, hypnosis explained a significant amount of variance in pain (R$\sp2$ Change =.17, F$\sb{\rm change}$ = 9.11, p =.0022), suffering (R$\sp2$ change =.30, F$\sb {\rm change}$ = 17.92, p =.0000) and state-anxiety (R$\sp3$ change =.15, F$\sb {\rm change}$ 11.41, p =.0008). There were no differences in analgesic use.Hypnosis had significant effects on treatment progress at Time 1 (F(2,44) = 11.70, p =.000) and Time 2 (F(2,44) = 9.99, p =.002). Hypnosis was negatively associated with complications (X$\sp2$ (1, N = 60) = 7.067, p =.008; Spearman's r = -.392, t = -3.247, p =.002). There were no between-group differences in length of hospitalization.Hypnosis subjects reported greater comfort during OT than controls at Time 1 (F(2,45) = 11.69, p =.000) and Time 2 (F(2,45) = 7.71, p =.004). No between-groups differences were found for observed comfort or cooperation with OT.These results indicate that cognitive-behavioral intervention with hypnotic suggestion can reduce patients' post-surgical perceived pain, suffering, and anxiety; decrease co-morbidity; and enhance post-surgical recovery and rehabilitation. Further research is needed to determine the generalizability of these findings to other orthopedic patient populations.

Keywords

Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery; Psychology, General

Link to Full Text

http://access.library.miami.edu/login?url=http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:9519731