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Am Fam Physician. 2017;96(10):online

Clinical Question

Can mind-body training, including mindfulness or self-hypnosis, decrease acute pain in hospitalized patients?

Bottom Line

Compared with psychoeducation, a single 15-minute session of training in mindfulness or self-hypnosis leads to greater immediate pain relief for hospitalized patients with at least moderate pain at baseline. (Level of Evidence = 1b)

Synopsis

For this single-site trial at a Utah hospital, these investigators randomized 244 hospitalized patients who reported intolerable pain or inadequate pain control to receive a single 15-minute session by a trained social worker using one of three interventions: (1) mindfulness training, focusing on breathing and acceptance of pain; (2) self-hypnosis, focusing on pleasing imagery and altering pain sensations; or (3) psychoeducation with delivery of empathic responses and pain-coping strategies. Baseline characteristics of the three groups were similar, with the exception that the hypnosis group had fewer women in it than the other two groups. In the overall sample, 94% were white, 57% were female, the mean age was 51 years, and all had moderate or greater pain at baseline.

The primary outcomes were self-reported pain intensity and unpleasantness scores before and after the intervention. Although patients in all three groups had reduced scores postintervention, patients in the mindfulness and hypnosis groups had significantly lower baseline-adjusted pain intensity and pain unpleasantness compared with the psychoeducation group. More patients achieved a clinically significant reduction in pain intensity of at least 30% in the mindfulness and hypnosis groups compared with the psychoeducation group (27%, 39%, and 15%, respectively). Pain relief was noted immediately following the intervention; the duration of this relief was not evaluated. Additionally, the power of suggestion and potential bias introduced by self-selection into the study may have played a role in the observed therapeutic effects.

Study design: Randomized controlled trial (nonblinded)

Funding source: Government

Allocation: Concealed

Setting: Inpatient (ward only)

Reference:GarlandELBakerAKLarsenPet alRandomized controlled trial of brief mindfulness training and hypnotic suggestion for acute pain relief in the hospital setting. J Gen Intern Med2017;32(10):1106–1113.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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