Pain Study on Children

QUESTION

Many children suffer from chronic and painful illnesses. Hypnosis was found to be effective for analgesia in adults. Is it effective for managing pain in children?

ANSWER

Children can be easier to hypnotize than adults. Studies have shown clinical hypnosis and self-hypnosis to be effective as adjunct treatments for children in pain. Examples include painful medical procedures, such as bone marrow aspiration and lumbar puncture in pediatric cancer patients, postoperative pain and anxiety in children undergoing surgery, and chronic headache.

Painful medical procedures

Hypnosis in painful medical procedures Hypnosis has been used to alleviate pain during bone marrow aspirations and lumbar punctures, which are the most painful and distressing procedures in treatment of children with cancer. A randomized controlled trial involving 30 children aged 5 to 15 years undergoing bone marrow aspiration found that children under hypnosis reported reduced pain compared with their own baseline and compared with a control group.7 Children with leukemia undergoing bone marrow aspiration reported similar pain and fear with hypnosis and with undirected play, but both hypnosis and play groups reported less pain and fear compared with baseline.8 Although 3- to 6-year-old patients with leukemia undergoing bone marrow aspirations under hypnosis reported no less pain, external observers reported immediate decreases in pain, anxiety, and distress in the hypnotic imaging group compared with distraction and control groups.9A study of the effects of direct and indirect hypnotic suggestions on lumbar puncture pain in 30 pediatric patients showed that levels of pain, anxiety, and distress were significantly lower after hypnotic analgesia.10 Hypnotherapy alleviated pain, distress, and anxiety much more than distraction during venipuncture, bone marrow aspiration, and lumbar puncture in highly hypnotizable children in another study of 27 patients aged 3 to 8 years.11 Similarly, hypnosis substantially reduced pain and anxiety during painful medical procedures in children and adolescents with cancer.12 Hypnosis was also successfully used to diminish pain and anxiety from angulated forearm fracture reduction in 4 pediatric emergency patients who had no access to other analgesia.13 Similarly, postoperative pain and anxiety were substantially lower in the hypnosis and guided imagery group than in the control group of a randomized controlled trial of 52 children undergoing surgery.

Is Hypnosis effective for Pain?

Hypnotherapy and self-hypnosis can be effective for managing chronic pain in children as well. Among more than 300 patients who presented to a pediatric pulmonary centre and received hypnotherapy, 80% of children with persistent chest pain reported improvement. No symptoms became worse and no new symptoms appeared following the treatment.Four of 5 children who received hypnotherapy for chronic functional abdominal pain experienced resolution of pain within 3 weeks.16 Self-hypnosis, which most children can learn, can be effective in managing recurrent headaches. Twenty-eight self-hypnotized children aged 6 to 12 years recorded fewer migraine headaches in their diaries than children in placebo and propranolol treatment groups did.

Summary

Results of controlled studies demonstrated that clinical hypnosis and self-hypnosis can be beneficial for children in pain. Studies found pediatric hypnosis effective for painful medical procedures, such as bone marrow aspiration and lumbar puncture during cancer treatment, for alleviating postoperative pain and anxiety in children undergoing surgery, and for headaches and some other conditions involving chronic pain.

References

1. Berman BM, Singh BB, Hartnoll SM, Singh BK, Reilly D. Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns. J Am Board Fam Pract. 1998;11(4):272–81. [PubMed]2. Verhoef MJ, Sutherland LR. Alternative medicine and general practitioners. Opinions and behaviors. Can Fam Physician. 1995;41:1005–11. [PubMed]

Hypnosis for treatment of pain in children

Alex L. Rogovik, MD PhD and Ran D. Goldman, MD

Pediatric Pearls is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program at the Hospital for Sick Children in Toronto, Ont. Dr Rogovik is Assistant Director and Dr Goldman is Director of the PRETx program. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine