From aromatherapy and acupuncture to music and massage, surgical facilities are turning to nonpharmacological alternative therapies to safely calm patients before surgery without drugs or sedation. When a patient is more relaxed, the less anxiety and pain he feels — and the less pain medication he needs. Here’s a look at a few of these low-cost interventions your colleagues are using.

• Hypnosis. Hypnosis has gone from hocus-pocus parlor trick to popular alternative therapy that some say reduces anxiety and pain almost as well as IV Versed. There’s no pendulating pocket watch, only ear buds and a loop of hypnotic recordings that lulls the patient into a state of deep relaxation in pre-op with soothing suggestions that his sensations are disappearing and reassurances that he’ll recover well and feel comfortable.

Hypnosis doesn’t put patients to sleep. It’s a form of guided meditation or altered consciousness, a tool for imagination or distraction to bypass reality, says Lynette Bear, DNP, CRNA, MBA, senior director of anesthesia administration at the Laser Spine Institute and a clinical hypnotist. As a patient goes deeper, he becomes more suggestible. Some Laser Spine patients listen to a hypnotic recording for about 10 minutes in pre-op. Dr. Bear designed the loop recording, which has no beginning or end.

Another recording she designed for use during anesthesia maintains the hypnotic state throughout surgery, instilling feelings of well-being, safety, security and comfort. “It’s important to state suggestions as a 'positive' phrase, suggesting what will happen,” says Dr. Bear. The intraop recordings also mention “light appetite,” which seems to help decrease post-operative nausea and vomiting (PONV).

In studies of the loop, Dr. Bear found that hypnotized patients experienced less PONV and spent 12% less time in recovery. They also required less anesthesia and emerged more alert.

Patients at the University of Florida Health in Gainesville, Fla., can tap into hypnotic language right in the waiting room with the My Comfort Talk app (comforttalk.com). It’s a collection of guided self-hypnosis scripts patients can listen to on their smartphones, says Irene M. Estores, MD, FAAPMR, director of UF Health Integrative Medicine and a clinical hypnotist. By following the app’s step-by-step directions, patients can find and choose a topic (relaxation, confidence, comfort, peace), time length and favored voice.

Can you avoid general anesthesia by using hypnosis? That’s what researchers at The University of Texas MD Anderson Cancer Center are about to find out. A study will examine 50 patients who are randomly selected to receive either general anesthesia or a combination of local anesthesia and “hypno-sedation” before and during surgery.

• Music. Listening to music also works to calm and soothe the patient. A study published in the April British Journal of Surgery (osmag.net/VuNN4w) says that music interventions significantly reduce anxiety and pain in adult surgical patients. The study found that the effect on anxiety was greatest when the music was played before surgery. For pain, the largest decreases were seen when playing music afterward.

You can synchronize music to a patient’s heartbeat and breathing, which can stabilize their vital signs, says musicologist Alice Cash, PhD, LCSW, of Surgical Serenity Solutions, which produces reusable wireless headphones pre-loaded with piano music patients can listen to as they undergo their procedure. Patients also can listen to their choice of tunes before and after surgery, which helps with pre-op anxiety and post-op confusion, she says.

“When they listen to the music, patients don’t wake up fighting the tubes,” says Dr. Cash. “They wake up relaxed, saying, 'This is the same music I was listening to when I fell asleep.'”

• Image-guided therapy. Instead of checking Facebook on their iPhones, give patients an iPad in pre-op and let them watch nature videos set to music. Studies show this image-guided therapy eases patients’ pre-op anxiety and raises their self-efficacy (the belief that you can).

“Anxiety has a direct affect on a person’s perception of pain,” says Margaret M. Hansen, EdD, MSN, CNL, RN, a semi-retired associate professor at the University of San Francisco School of Nursing & Health Professions. “If you reduce anxiety, you also increase their belief that they will be able to take care of themselves after surgery. That is what you want with a surgical patient.” OSM