To assess whether adjunct self-hypnotic relaxation reduces pain and anxiety during image-guided large core needle biopsy of the breast (LCNB).

236 women referred for LCNB 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 LCNB. Patients’ self-ratings at 10 minute-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, compared in an ordinal logistic regression model.

Women presented with elevated anxiety. Anxiety increased further 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). Anxiety increased more with standard care than empathy and hypnosis and decreased more with hypnosis than empathy (all p < 0.01). 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 provider: 46 minutes/$161 for standard care, 43 minutes/$163 for empathy, and 39 minutes/$152 for hypnosis.

While both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost.

Self hypnotic relaxation offers patients during large core needle breast biopsy a drug free choice for reducing pain and anxiety without adding procedure time, cost, or side effects.