آرام سازی خواب آور خود کمکی برای روش های پزشکی سرپایی: یک کارآزمایی تصادفی آینده نگر با زنان تحت بافت برداری از سینه هسته بزرگ

Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n = 76), structured empathic attention (n = 82), or self-hypnotic relaxation (n = 78) during their procedures. Patients’ self-ratings at 10 min-intervals of pain and anxiety on 0–10 verbal analog scales with 0 = no pain/anxiety at all, 10 = worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women’s anxiety increased significantly in the standard group (logit slope = 0.18, p < 0.001), did not change in the empathy group (slope = −0.04, p = 0.45), and decreased significantly in the hypnosis group (slope = −0.27, p < 0.001). Pain increased significantly in all three groups (logit slopes: standard care = 0.53, empathy = 0.37, hypnosis = 0.34; all p < 0.001) though less steeply with hypnosis and empathy than standard care (p = 0.024 and p = 0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/$161 for standard care, 43 min/$163 for empathy, and 39 min/$152 for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.

Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. Nonpharmacologic adjuncts in these busy settings are largely under-investigated. This leaves patients with little help. The situation is aggravated when the procedure involves pain and is highly anxiety provoking. We therefore chose large core breast biopsy as a model in which to assess the efficacy of biobehavioral interventions. Breast cancer is one of the most common and feared cancers among women, affecting as many as one in eight (American Cancer Society, 2005). Screening mammography enables early detection and can improve chances of successful treatment and survival (Tabar et al., 2003). In the US, more than 60% of women aged 40 or older undergo mammography each year (Centers of Disease Control and Prevention (CDC), 2002). Five to ten percent of mammograms yield abnormal or inconclusive results that require further work-up (American Cancer Society, 2005). For these patients and also those with lumps found by palpation, image-guided large core needle biopsy (LCNB) has evolved as a reliable diagnostic tool (Meyer et al., 1999). LCNB is typically performed in outpatient settings with local anesthetic (American College of Radiology, 2000) which reduces cost (Groenewoud et al., 2004) but limits the use of intravenous drugs to reduce pain and anxiety. Some advocate the use of oral anxiolytics (van Vlymen et al., 1999 and Bugbee et al., 2005) but these restrict patients from driving and working after the procedure. In a mammography study, psychological intervention was found to reduce distress in select patients (Caruso et al., 2001). In a study of breast biopsies, relaxation treatment yielded no demonstrable effects (Bugbee et al., 2005). Encouraged by a prior report which showed less pain, anxiety, and need for intravenous medication in patients having self-hypnotic relaxation during more invasive medical procedures (Lang et al., 2000), we hypothesized that such an intervention could reduce pain and anxiety in patients undergoing LCNB. Thus we designed the following prospective randomized trial.