International Urology and Nephrology

, Volume 47, Issue 11, pp 1773–1777 | Cite as

The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety

  • Fatih Hızlı
  • Osman Özcan
  • İsmail Selvi
  • Pınar Eraslan
  • Aydın Köşüş
  • Okan Baş
  • Taha Numan YıkılmazEmail author
  • Oğuz Güven
  • Halil Başar
Urology - Original article



Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

Materials and methods

Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant.


Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0–8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001).


The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.


Prostate needle biopsy Pain Anxiety Hypnotherapy 



Special thanks to Associated Professor Dr. Aydın Köşüş for his valuable analysis and support in this paper’s statistical analysis and comment.

Compliance with ethical standards

Conflict of interest

No conflict of interest was declared by the authors.

Ethics committee approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from patients who participated in this study.


  1. 1.
    Goldmann L, Ogg TW, Levey AB (1988) Hypnosis and daycase anaesthesia: a study to reduce pre-operative anxiety and intra-operative anaesthetic requirements. Anaesthesia 43:466–469CrossRefPubMedGoogle Scholar
  2. 2.
    Montgomery GH, Weltz CR, Seltz G, Bovbjerg DH (2002) Brief presurgery hypnosis reduces distress and pain in excisional breast biopsy patients. Int J Clin Exp Hypn 50:17–32CrossRefPubMedGoogle Scholar
  3. 3.
    Poole K (1997) The emergence of the ‘waiting game’: a critical examination of the psychosocial issues in diagnosing breast cancer. J Adv Nurs 25:273–281CrossRefPubMedGoogle Scholar
  4. 4.
    Montgomery GH, Bovbjerg DH (2004) Pre-surgery distress and specific response expectancies predict post-surgery outcomes in surgery patients confronting breast cancer. Health Psychol 23:381–387CrossRefPubMedGoogle Scholar
  5. 5.
    Ozalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N (2003) Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 47:26–29CrossRefPubMedGoogle Scholar
  6. 6.
    Loeser JD, Melzack R (1999) Pain: an overview. Lancet 353:1607–1609CrossRefPubMedGoogle Scholar
  7. 7.
    Mann A (1998) A continuing postoperative complication: nausea and vomiting who is affected, why, and what are the contributing factors? A review. CRNA 9:19–29PubMedGoogle Scholar
  8. 8.
    Johnston M, Vogele C (1993) Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med 15:245–256Google Scholar
  9. 9.
    Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH (2002) The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg 94:1639–1645PubMedGoogle Scholar
  10. 10.
    Lynn SJ, Martin DJ, Frauman DC (1996) Does hypnosis pose special risks for negative effects? Int J Clin Exp Hypn 44:7–19CrossRefPubMedGoogle Scholar
  11. 11.
    Holroyd J (2003) The science of meditation and the state of hypnosis. Am J Clin Hypn 46:109–128CrossRefPubMedGoogle Scholar
  12. 12.
    Ulusoy M, Şahin NH, Erkmen H (1998) Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cogn Psychother 12:163–172Google Scholar
  13. 13.
    Yazici MK, Demir B, Tanriverdi N, Karaagaoglu E, Yolac P (1998) Hamilton anxiety rating scale: inter-rater reliability and validity study. Turk J Psychiatry 9:114–117Google Scholar
  14. 14.
    Campbell WI, Lewis S (1990) Visual analogue measurement of pain. Ulster Med J 59:149–154PubMedCentralPubMedGoogle Scholar
  15. 15.
    Ahearn EP (1997) The use of visual analog scales in mood disorders: a critical review. J Psychiatr Res 31:569–579CrossRefPubMedGoogle Scholar
  16. 16.
    Bastide C, Lechevallier E, Eghazarian C, Ortega JC, Coulange C (2003) Tolerance of pain during transrectal ultrasound-guided biopsy of the prostate: risk factors. Prostate Cancer Prostatic Dis 6:239–241CrossRefPubMedGoogle Scholar
  17. 17.
    Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A (2001) The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol 165:445–454CrossRefPubMedGoogle Scholar
  18. 18.
    Rodriguez LV, Terris MK (1998) Risks and complications of transrectal ultrasound guided prostate needle biopsy: a prospective study and review of the literature. J Urol 160:2115–2120CrossRefPubMedGoogle Scholar
  19. 19.
    Enqvist B, Bjorklund C, Engman M, Jakobsson J (1997) Preoperative hypnosis reduces postoperative vomiting after surgery of the breasts: a prospective, randomized and blinded study. Acta Anaesthesiol Scand 41:1028–1032CrossRefPubMedGoogle Scholar
  20. 20.
    Goldmann L, Ogg TW, Levey AB (1988) Hypnosis and daycase anaesthesia. A study to reduce pre-operative anxiety and intra-operative anaesthetic requirements. Anaesthesia 43:466–469CrossRefPubMedGoogle Scholar
  21. 21.
    Greenleaf M, Fisher S, Miaskowki C, DuHamel K (1992) Hypnotizability and recovery from cardiac surgery. Am J Clin Hypn 35:119–128CrossRefPubMedGoogle Scholar
  22. 22.
    Issa MM, Bux S, Chun T, Petros JA, Labadia AJ, Anastasia K, Miller LE, Marshall FF (2000) A randomized prospective trial of intrarectal lidocaine for pain control during transrectal prostate biopsy: the Emory University experience. J Urol 164:397–399CrossRefPubMedGoogle Scholar
  23. 23.
    Leibovici D, Zisman A, Siegel YI, Sella A, Kleinmann J, Lindner A (2002) Local anesthesia for prostate biopsy by periprostatic lidocaine injection: a double-blind placebo controlled study. J Urol 167:563–565CrossRefPubMedGoogle Scholar
  24. 24.
    De Witte JL, Alegret C, Sessler DI, Cammu G (2002) Preoperative alprazolam reduces anxiety in ambulatory surgery patients: a comparison with oral midazolam. Anesth Analg 95:1601–1606CrossRefPubMedGoogle Scholar
  25. 25.
    Oshima T, Kasuya Y, Terazawa E, Nagase K, Saitoh Y, Dohi S (2001) The anxiolytic effects of the 5-hydroxytryptamine-1A agonist tandospirone before otolaryngologic surgery. Anesth Analg 93:1214–1216CrossRefPubMedGoogle Scholar
  26. 26.
    Wang SM, Peloquin C, Kain ZN (2001) The use of auricular acupuncture to reduce preoperative anxiety. Anesth Analg 93:1178–1180CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Fatih Hızlı
    • 1
  • Osman Özcan
    • 2
  • İsmail Selvi
    • 1
  • Pınar Eraslan
    • 1
  • Aydın Köşüş
    • 2
  • Okan Baş
    • 1
  • Taha Numan Yıkılmaz
    • 1
    Email author
  • Oğuz Güven
    • 1
  • Halil Başar
    • 1
  1. 1.Ankara Oncology Research and Treatment CenterAnkaraTurkey
  2. 2.Turgut Özal UniversityAnkaraTurkey

Personalised recommendations