Hypnosis revived as a complement to sedatives

By Stephen Smith, Globe Staff, 10/29/2002

The woman's voice dances like spring rain on a tin roof.

''Just imagine your whole body floating,'' the woman says to the man prone on an operating table. ''Right now, you're going to imagine floating someplace safe and comfortable - a lake, a hot tub, or just in space.''

The woman is Dr. Elvira V. Lang, a conventionally trained interventional radiologist practicing at one of the high temples of conventional medicine, Beth Israel Deaconess Medical Center. Lang has embraced a practice once scorned as the tomfoolery of circus charlatans - hypnosis. And she uses it in the operating room, in place of mind-numbingly heavy doses of sedatives.

Lang finds herself astride the fault line separating traditional and alternative medicine, two worlds once galaxies apart. Slowly, sometimes grudgingly, those worlds are moving into closer alignment, with some on each side willing to learn from the other.

And she has the data to prove the wisdom of her convictions: Research shows that hypnosis reduces hospital stays, speeds healing, and even saves money - scientific evidence that hypnosis partisans cite when attempting to convert often-wary colleagues.

''It's not that hypnosis is a magic wand. It's not. But it has been shown useful in a variety of medical applications,'' said Harvard psychologist Carol Ginandes, who is professionally trained in hypnotherapy. ''Still, there is a lot of skepticism. ... There are a lot of myths, and medical professionals are not immune to that.''

In fact, much like the rehabilitated reputation of the long-sullied leech, hypnosis is one of those back-to-the-future phenomena that mark the ebb and flow of medicine.

The history of medical hypnosis traces back at least as far as the 19th century. It was a time when neither infection control nor pain management were hallmarks of medical care.

It took a Scottish surgeon who had done a rotation in India, where he witnessed hypnosis, to introduce the technique to the West. But, before he could win over dubious colleagues, anesthesia came along, and medical hypnosis was relegated to the slag-heap of technologically upstaged concepts.

And so it was until the late 20th century, when even the federal government began investigating the worthiness of pills, potions, and procedures previously dismissed as the province of the unscrupulous or the unenlightened.

Elvira Lang was a Stanford University medical professor a decade ago when she first encountered medical hypnosis.

A patient who had had a big swath of intestines removed needed to have a replacement tube drained regularly, but because anxiety seized him, a 10-minute procedure would wind up taking more than an hour. A technologist working with Lang one day asked if she could attempt to calm the man using imaging techniques - encouraging the patient to believe he was someplace, anyplace, other than a hospital.

It worked. And Lang was launched on an odyssey that would take her into the realm of hypnosis, as practitioner, researcher, and acolyte.

It is a place where Dr. Anne Ouellette dwells, too. She is a hand surgeon at the University of Miami, where she has used hypnosis to relax patients in both the operating suite and in their hospital rooms, where they have bandages changed, stitches removed.

Ouellette does not cajole patients into adopting relaxation techniques. Instead, she lets them broach it, although Ouellette clearly advocates its benefits.

''I prefer my patients to be a little more alert and talking to me,'' the surgeon said. ''If they're not anxious, I'm not anxious. We all calm down.''

But Ouellette, like Lang, demands objective data showing that hypnosis really works.

In one study, Ouellette tracked patients who received hypnosis and patients who did not. The hypnosis patients experienced no serious problems following surgery, while two patients who had not undergone relaxation techniques sustained complications so severe that amputations were necessary.

''That data was a poke to the medical world,'' Ouellette said, ''a way to say, `Oh, guys, if you're really interested in your outcomes, this will help you.'''

Lang's research has yielded much the same message, albeit in a different medical specialty. She employs hypnosis in interventional radiology, a field that uses the smallest of incisions and tiniest of medical instruments to repair patients. As with Ouellette, hypnosis is not an either-or proposition: Most patients still get sedatives, although at dramatically reduced levels.

In one study that examined outpatients undergoing procedures such as angioplasty, Lang found that hypnosis in conjunction with lowered amounts of sedatives cost less than half what standard sedation did.

Another piece of research showed that pain levels remained flat, and low, among surgical patients assigned to a study group that received hypnosis, while pain steadily rose among patients on standard sedatives. Plus, the hypnosis patients left the operating room 17 minutes sooner than the other patients.

That kind of rigorous research persuaded Lang's boss to let her use hypnosis, which remains largely experimental and ineligible for insurance reimbursement.

''I was neither a major champion of this nor a major opponent,'' said Dr. Herbert Kressel, radiologist in chief at Beth Israel Deaconess. ''I just thought it could be a benefit to patients, because we would like to create an environment that gives them the least pain and anxiety.''

But while hypnosis can be useful, it's no panacea, a leading anesthesiologist said. Dr. David Birnbach, chairman of the committee on obstetric anesthesia of the American Society of Anesthesiologists, has witnessed hypnosis in the delivery room.

''The problem is that for many women, it does not work to any extent that it would help,'' Birnbach said. ''The few people who have tried it have reported that the results have not been as promising as hoped.''

Still, the anesthesiologist conceded, hypnosis does appear to be helpful in medical procedures that don't cause pain as acute as childbirth. ''Clearly,'' Birnbach said, ''it can be a wonderful tool as an adjunct to anesthesia. But in no way, shape, or form does it replace anesthesia in the operating room.''

On this day, in a Beth Israel Deaconess procedure room, Lang's patient is Vincent Dibiasio of Canton, who has a blockage in a leg artery. Dibiasio is, as one of Lang's colleagues put it, ''a frequent flyer'' with the interventional radiology team, having endured a number of procedures.

''The doctor asked me if I would be interested in doing hypnosis,'' said Dibiasio, 56, an insurance appraiser. ''And I said, `Doctor, I'm on the table. Where am I going to go? You've got me.'''

Bathed in the soothing patter of Lang's hypnotic words, Dibiasio moans gently, sighing peacefully.

''Where do you see yourself?'' Lang asks Dibiasio.

''In Aruba,'' he answers. ''Beautiful beaches, beautiful women, good food, nice people.''

Lang's murmurs encourage Dibiasio to envision a stone skipping on a lake, water rippling as the stone plunges deeper and deeper. The patient would later recall that his visit to the hospital was surprisingly relaxing.

''It's like the sunshine spreading throughout your body and into your leg,'' Lang said. ''It's already in there.

''Neat, huh?''

Stephen Smith can be reached at stsmith@globe.com.

This story ran on page D1 of the Boston Globe on 10/29/2002.

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