Hypnosis for burn-related pain: Case studies and a review of the literature

Table 1 Controlled trials

Ref.	Outcome and measurement method	Intervention	n	Randomization	Hypno-tizability considered	Control condition	Age range	Significant results
Wakeman et al[22] (1978)	Pain intensity Medication usage	During procedures + sessions to teach self-hypnosis Inductions varied between patients (eye-fixation, eye-roll, progressive muscle relaxation) Suggestions for analgesia, anesthesia, and anxiety reduction	42	No	No	Attention	7-70	Less medication with hypnosis (approximately 42.5% less medication overall) Under 18 used less medication than adults
Moore et al[23] (1983)	Unilateral healing Skin temperature and observation of inflammation	Suggestions for increased blood flow to injured area	5	No	No	SC on half of body (patient was own control)	Adults	Rapid unilateral healing in 4/5 patients Rapid bilateral healing in 1/5 patients
Margolis et al[24] (1983)	Physiological response Fluid input/urine output (fluid retention)	Single early induction Suggestions for coolness and comfort with visual imagery	22	No	Yes (clinical observation)	SC	Adults	No significant between group difference in fluid input Day 2 urine output higher with hypnosis in those judged to be at least mildly hypnotized Percentage urine output higher for hypnosis than control
Hammond et al[25] (1983)	Pain VAS Inflammation reduction Temperature and observation of redness	≥ 2 h of hypnotic training by therapist Suggestions for coolness and analgesia on one leg	6	No	Yes (ability to develop glove anesthesia)	No treatment on other leg (patient was own control)	Adults	No pain reported on treated leg Sig trend of lower temperatures on treated leg Lower redness ratings on treated leg
Patterson et al[26] (1989)	Pain (dressing change and debridement) VAS	RIA Hypnosis done prior to procedure + nurses providing posthypnotic cues during	13	No	No	Historical	Adults	Lower pain scores with hypnosis
Patterson et al[27] (1992)	Pain (during debridement) Medication use VAS (patient-rated, nurse-rated)	RIA on day 2 before procedure Visualize descending a staircase Included posthypnotic suggestions for analgesia cue to be given during procedure	30	Yes	No	Attention (placebo hypnosis), SC	Adults	No sig medication difference between groups Reduction of patient-rated pain with hypnosis Reduction of nurse-rated pain score with hypnosis
Everett et al[60] (1993)	Pain (during debridement) VAS (patient-rated, nurse-rated) Medication use	Modified RIA on days 3 and 4 before debridement Included posthypnotic suggestions for cool numbness cue to be given during debridement	32	Yes	No	Attention, Ativan	Adults	No sig pain difference between groups No sig medication difference between groups
Patterson et al[28] (1997)	Pain (during debridement) VAS (patient-rated, nurse-rated) Opioid intake	Modified RIA on day 4 before debridement Included posthypnotic suggestions for cool numbness cue to be given during debridement	61	Yes	No	Attention	Adults	No sig pain difference between groups Less pain with hypnosis with high baseline pain Nurses rated less pain with hypnosis No sig medication difference between groups
Wright et al[29] (2000)	Pain (dressing change and debridement) Medication usage Pain intensity NRS Pain distress NRS Relaxation	Modified RIA during wound care	30	Yes	No	SC	16-48	Less medication use with hypnosis Reduced pain intensity and distress with hypnosis after first hypnosis session Increased relaxation with hypnosis after wound care
Harandi et al[30] (2004)	Pain VAS Procedural anxiety VAS	Modified RIA for ≥ 2 d	44	No	Yes (Davis-Husband scale)	SC	16-75	Reduction of pain and anxiety with hypnosis N of sessions correlated with lower pain and anxiety
Askay et al[31] (2007)	Pain (during debridement) McGill Pain Questionnaire -Short Form	Modified RIA Audio-recorded	46	Yes	Yes (SHCS)	Attention	Adults	Lower McGill pain score with hypnosis
Shakibaei et al[32] (2008)	Pain and re-experiencing of trauma Pain NRS Number of patients’ recollections of vivid, troubling events the day before	Hypnosis done outside of procedures (to focus on background pain) Eye fixation induction for adults Doll or teddy bears used in induction for children Guided imagery of a cold bath and pain dissipating Posthypnotic suggestions for analgesia and improved sleep	44	Yes	No	SC	6-62	Lower pain ratings with hypnosis compared to control Pain reduction from baseline to 5th session Reduction in re-experiencing scores with hypnosis from baseline to 3rd session and baseline to 5th session
Berger et al[33] (2010)	Pain VAS Anxiety ESAS for anxiety Opioid usage Patient charts Economical costs Analytic accounting system	Hypnosis delivered by trained nurse during wound care Induction and suggestions varied according to observation of patient's behavior	23	No	No	Historical	adults	Pain reduction with hypnosis Anxiety reduction with hypnosis Mean opioid doses lower with hypnosis Net savings of €174640

Sig: Significant; SC: Standard care; SHCS: Stanford hypnotic clinical scale; VAS: Visual analogue scale; NRS: Numeric rating scale; RIA: Rapid induction analgesia[59]; ESAS: Edmonton symptom assessment scale.