Hypnosis for Pediatric Pain: Findings from a New Literature Review

• The review examined hypnosis for the management of procedural pain and/or distress in children.
• Subject age ranged from 4 to 22 years, although the review did not include a specific definition of adult patients.
• 38 studies that included 2205 subjects fit the review’s requirements.
• The most common procedures studied (identified in 42% of studies) involved oncology treatments, followed by surgical and miscellaneous procedures including burn treatments (21%) and dental procedures (18%).

• Outcome measures: Pain intensity and indicators of pain (most notably analgesic use) and of distress as determined by levels of fear, anxiety, and stress markers (blood pressure, heart rate).
• 76% of the studies involved multiple assessors including the children, parents, and observers in determining effects.
• The type of therapeutic modalities compared against hypnosis varied widely among the studies.

• Hypnosis was found superior to several modalities including ones that share aspects of hypnosis, such as active cognitive strategies, distraction, control, and progressive muscle relaxation.
• In the few studies comparing hypnosis with medication management, relief was at least as effective with hypnosis as that provided by opioids and anxiolytics.
• Additional benefits were observed when hypnosis and medication were combined.

• Rates of refusal to participate in the studies ranged from 0%-52%.
  • Reasons given by parents for refusal to allow their children to participate included concern that the hypnosis training might bring more attention to the procedure and increase the child’s anxiety; might remind the child of their illness; and religious reservations.
• Attrition rates also varied widely, from 2%-52% in the studies that reported them with reasons for dropping out including lack of perceived benefits from the hypnosis, insufficient motivation, and a child’s discomfort during the treatment.

• Review authors noted a wide range of hypnotic techniques employed across the studies.
  • Some utilized a live hypnotist while others relied on prerecorded instructions.
  • Presence of a live hypnotist appeared to be more effective.
• 76% of studies included attempts to tailor hypnosis to individual patients, making comparison of treatments across studies difficult.

• There were also differences in level of training and experience among those providing hypnosis with practitioners in many studies having little, if any experience in the technique.
• There was insufficient information in ~50% of the studies to determine the clinician's level of experience or training.
• Due to variation across the studies in the level of clinician experience with hypnosis, it is difficult to determine any correlation between the level of experience and efficacy of the treatment.

• Ideally, the person providing the therapy should be trained in hypnosis and provide it in-person, although this option may not always be available or feasible.
• The analysis findings suggest, however, that even treatment by a clinician with limited experience or hypnosis provided by recording devices, may provide some benefit.

To better identify patients most likely to benefit from hypnosis and what forms are efficacious for which children, more studies are needed with additional standardized methods of hypnosis, as well as complete information on the clinician, patient, and parents.