387: Clinical Hypnosis for Acute Perioperative Pain and Opioid Use: A Systematic Review

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Non-pharmacological treatments, Treatment/management

Background and Aims: Postoperative pain remains inadequately controlled for many surgical patients and is associated with greater morbidity, impaired function, delayed recovery, prolonged opioid use, increased healthcare costs, and elevated risk of chronic postsurgical pain1. Clinical hypnosis is increasingly proposed as an opioid‑sparing adjunct within multimodal analgesia, but its effectiveness in adults undergoing surgery under general, spinal, or regional anaesthesia remains uncertain. We aimed to synthesise randomized trial evidence on the effects of hypnosis on acute perioperative pain intensity, perioperative opioid and sedative consumption, and related psychological outcomes in adult surgical patients, and to identify key gaps and priorities for future research.

Methods: We conducted a prospectively registered systematic review (PROSPERO CRD420251023151) following JBI methodology and PRISMA 2020 guidance. Six databases (MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, Google Scholar) were searched to April 2025 for randomized controlled trials comparing clinical hypnosis (live, audio, or virtual reality–delivered) with standard care or attention control in adults (≥18 years) undergoing surgery under general, spinal, or regional anaesthesia. Two reviewers independently screened, extracted data, and appraised risk of bias using JBI tools and RoB 2.0. Due to substantial clinical and methodological heterogeneity, we performed structured narrative synthesis and graded certainty of evidence with GRADE.

Results: Eleven trials (N=679)2-12 from nine countries included orthopaedic, cardiac, breast, rhinoplasty, and oncologic surgery. Hypnosis was delivered at various perioperative timepoints via live therapists, audio recordings, or virtual reality. Eight trials (n=540)2,5,6,8,10,11 reported perioperative opioid or sedative outcomes; six showed significant reductions favouring hypnosis, typically around 29–74%, including a 54% 24‑hour reduction in opioid‑experienced knee arthroplasty patients8. Across 11 trials, pain intensity findings were heterogeneous: approximately half of trials reported benefits and half were null. Anxiety, catastrophizing, pain interference, wound healing, and satisfaction improved where measured but were infrequently assessed. No hypnosis‑related serious adverse events were reported.

Conclusions: In adults undergoing major surgery under general, spinal, or regional anaesthesia, clinical hypnosis appears to confer modest but clinically relevant reductions in perioperative opioid and sedative consumption, with more variable effects on acute pain intensity yet promising benefits for anxiety, catastrophizing, and pain interference. The partial dissociation between opioid‑sparing and pain‑intensity effects suggests preferential modulation of affective and cognitive pain dimensions and analgesic‑seeking behaviour rather than sensory intensity alone.
Small sample sizes, heterogeneity, and risk‑of‑bias concerns limit certainty and highlight the need for rigorously designed trials with mechanistic measures and longer‑term pain and opioid outcomes, including chronic postsurgical pain.

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Presenting Author: Ana-Maria Toth
Submitting Author: Ana-Maria Toth

Senior Author: Jan Vollert

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Veronica Price: MCLIP - Somerset NHS Foundation Trust
• Sophie Knipe: MBBS - Royal Devon University Healthcare NHS Foundation Trust
• Marianne Hollyman: MRCS - Somerset NHS Foundation Trust
• Jan Vollert: PhD - Exeter University