Applying Hypnosis in Dermatology

Philip D. Shenefelt

Disclosures

Dermatology Nursing. 2003;15(6) 

In This Article

Hypnotic Relaxation During Dermatologic Surgery

A variety of dermatologic procedures can produce pain or anxiety in patients. Skin procedures that are somewhat painful but usually do not require local anesthetic include moderate-depth chemical peels, cryodestruction of skin lesions, curettage of molluscum, excision of skin tags, extrusion of comedones, incision and expression of milia, laser treatment of vascular lesions, strong microdermabrasion, and sclerotherapy. Dermatologic procedures that require local anesthetic include electrodesiccation and curettage, incision and drainage of abscesses, laser ablation of skin lesions, liposuction, punch biopsy, shave biopsy, surgical excision, and surgical repair. Cutaneous procedures that may require conscious sedation include deep chemical peel, dermabrasion, laser resurfacing, and extensive liposuction. All of these procedures may be augmented by hypnotic relaxation and/or hypnotic analgesia.

For the majority of people, hypnotic suggestion relieves pain regardless of the type of pain they are experiencing. Light and medium trance is sufficient for most purposes, but deep trance is required for hypnotic anesthesia for surgery. Montgomery, Weltz, Seltz, and Bovbjerg (2002) studied 20 women randomized to standard care versus preoperative hypnosis for excisional breast biopsy. They found brief (10 minute) hypnosis to be effective in reducing postsurgery pain and distress both before and after surgery. Lang et al. (2000) conducted a prospective randomized trial of adjunctive nonpharmacologic analgesia for invasive radiologic procedures with three groups: percutaneous vascular radiologic intraoperative standard intravenous (IV) conscious sedation care, structured attention, and IV conscious sedation that included self-hypnotic relaxation. Pain increased linearly with time in the standard and the attention group, but remained flat in the hypnosis group. Anxiety decreased over time in all three groups, but more so with hypnosis. Drug use was significantly higher in the standard group, intermediate in the structured attention group, and lowest in the self-hypnosis group. Hemodynamic stability was significantly higher in the hypnosis group than in the other two groups. Procedure times were significantly shorter in the hypnosis group than in the standard group. Their conclusions were that hypnosis was better in reducing pain and anxiety, in maintaining hemodynamic stability, and in shortening procedure time than standard intraprocedural care; structured attention was in between hypnosis and standard care.

Letting the patient choose his or her own self-guided imagery seems to allow most individuals to reach a state of relaxation during procedures. Shenefelt (2003) has used this technique modified from the invasive radiologic studies for dermatology with good success in dermatologic surgery. Shenefelt (2003) developed a script for trance induction, maintenance, and termination. It consists of a rapid eyeroll induction just before the surgical procedure, deepening through floating, self-guided imagery trancework during the surgical procedure, and trance termination after the procedure.

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