Apr 21 2008

Surgery Under Hypnosis

Over the weekend there have been numerous new reports breathlessly reporting the case of Alex Lenkei who underwent ordinarily painful hand surgery using hypnosis instead of anesthesia. At face value, the reports are stunning. Mr. Lenkei, who is a professional hypnotist, “hypnotized” himself prior to having surgery on his right hand for osteoarthritis. The surgery involved opening up the skin and tissue over the thumb and wrist down to the bone, sawing and chipping away bone, and fusing bones. Mr. Lenkei reports feeling no pain during the procedure, just some pulling and prodding. The surgeon, David Llewellyn-Clark, reports that his vital signs were monitored during the procedure and were stable, indicating that he was feeling no pain.

What should an open-minded skeptic make of such a tale?

Let us consider all possible explanations and evaluate them for plausibility and also see if they jibe with the facts as presented in the media. I read about 30 accounts of the story, and watched the video interview with Mr. Lenkei and Dr. Llewellyn-Clark.  On the whole I was very disappointed in the reporting. None of the reporters asked the questions I would have asked, and I had to read many accounts to piece together the details that I do have. I think this reflects the need for dedicated science journalists – but that’s another blog post.

I have e-mailed the hospital and I am trying to get contact information for Dr. Llewellyn-Clark so that I can fill in the missing details. If I do I will add an addendum to the post with the new information. Meanwhile, here are several possible hypotheses to explain this story.

Hypothesis #1 – The story is true as reported.

If the story is accurate and correct as reported, then Mr. Lenkei had no anesthesia and his only form of pain control was his self-hypnosis.  I find this to be highly implausible. As a matter of definition – we must first distinguish stage-hypnotism from the kind used by Mr. Lenkei, which is probably better described as deep meditation.

It is true that pain is a subjective experience and is highly modified by our mood and attention. If we focus on the pain, even a minor pain can become very bothersome. Likewise, if we are distracted from our pain it can diminish significantly. Fear and anxiety will also tend to exacerbate the perception of pain. So it is plausible that using meditation to focus one’s attention elsewhere and keep oneself calm and free from fear and anxiety will significantly reduce the perception of pain. This can also reduce the need for sedation and pain killing surrounding a surgical procedure.

This technique is called hypnoanesthesia and it has been around for a few decades. However, hypnoanesthesia involves “hypnosis, local anesthesia and minimal conscious sedation.” That’s right – local anesthesia and conscious sedation. The hypnosis component is used to minimize the amount of sedation required – but does not obviate the need for local anesthesia. Local anesthesia means using lidocaine injections (or a similar medication) to numb the nerve endings in the location of the surgery. Conspicuously absent from every news report of the Lenkei case was any specific mention of local anesthesia (more on this below).

If we assume that the news reports, however, were accurate in saying the Mr. Lenkei has no anesthesia at all – not local or general – is it feasible that he could feel no pain from such a procedure through self-hypnosis alone? I don’t think so. There are naturally occurring endorphins in the nervous system that bind to receptors that decrease pain perception. It is these receptors that opiates – morphine-like drugs – bind to and activate. So it is possible that Mr. Lenkei could have learned through practice to respond to pain with a large dose of endorphins (or perhaps it is just natural for him to do so) and this significantly blunted the pain.

However – endorphins would not make one numb to the painful stimulus. It would reduce the perception of pain and specifically reduce the emotional content of pain, but would not render one numb. Mr. Lenkei reported feeling no pain at all. I consider this to be highly implausible.

Also of note the news stories report that Mr. Lenkei put himself into a hypnotic “trance” and yet during the procedure he was chatting with the surgeon – asking him how the procedure was going. He was also aware of conversations in the room and various sensations of the surgery – like pulling, and noted that his arm was in an uncomfortable position and he felt like he wanted to move it. This does not sound like much of a trance.

Hypothesis #2 – Local Anesthesia

As I stated above, hypnoanesthesia involves reduced sedation but still includes the use of local anesthesia to block the pain. Given that this detail was not specifically reported, I think the most likely explanation of this story is that Mr. Lenkei received injections to numb the region of surgery. He used self-hypnosis to remain clam and still, and therefore did not require any sedation.  If this scenario is true, then all the news reports were wildly misleading to the general public.

I find this hypothesis to be far and away the most plausible and likely.

Hypothesis #3 – His hand was already numb

Mr. Lenkei has severe osteoarthritis of the right hand – that was the focus of the surgery. It is possible that he also had nerve damage in his hand. Perhaps he has severe carpal tunnel syndrome and ulnar neuropathy -meaning that two of the main nerves that supply sensation to the hand are damaged. Therefore he may not have needed anesthesia because his hand was already profoundly numb. The surgeons may not have been aware of this (they are bone surgeons and perhaps did not document a careful neurological exam – not uncommon in my experience) and therefore they were “stunned” by Mr. Lenkei’s ability to tolerate the surgery.

Hypothesis #4 – Mr. Lenkei cheated.

Mr. Lenkei is a practicing hypnotist, and he may have seen his surgery as an opportunity to demonstrate the power of his craft and garner some free press.  If that was his goal, he succeeded spectacularly. It is possible that he has pulled off a stunt, fooling his surgeons and the press. He could easily have obtained some narcotics, for example, and then medicated himself just prior to the surgery.

Hypothesis #5 – Multi-factorial

Finally, we may be dealing with a combination of factors.  Perhaps Mr. Lenkei naturally has a very high pain threshold, and he has some nerve damage in that hand and therefore has reduced sensation. He may also have taken some pain medications prior to the surgery, or perhaps had some local anesthesia that is not being reported.

Conclusion

To be clear – I am not accusing Mr. Lenkei or his surgeons of anything. I am simply laying out various hypotheses given the information available on this story. I would love to have the opportunity to test these hypotheses, by questioning Mr. Lenkei and/or his surgeon. The question of local anesthesia should be the easiest to resolve.

If only the mainstream media utilized more dedicated science journalists – and in a health-related case ones with medical training. A skeptical and knowledgeable journalist should have asked the penetrating questions to ascertain whether or not this story is actually true. Instead the public was treated to a superficial and sensationalized account that is likely highly misleading.

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