Can Fam Physician. 2007 May; 53(5): 823–825. PMCID: PMC1949166
Hypnosis for treatment of pain in children
Alex L. Rogovik, MD PhD and Ran D. Goldman, MD
Abstract
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.
Hypnosis, known since the late 18th century, was recently accepted by the American Medical Association as a medical treatment when administered by an appropriately trained practitioner. A survey of 783 US primary care physicians found that 19.9% of them had used hypnosis, and 62.9% of pediatricians had used or would use hypnotherapy.1 Twenty percent of surveyed Canadian general practitioners had had training in complementary and alternative medicine, including hypnosis.2
Children behave differently from adults under hypnosis. While adults are usually cataleptic, children often fidget or appear restless during procedures. Highly hypnotizable children need no induction. Children’s vivid imaginations combined with stressful experiences elevate their receptivity to hypnosis.
Pediatric hypnosis has been used not only for pain control, but also in treatment of many disorders, including anxiety, phobias, posttraumatic stress, sleep walking, behavioural disorders, conversion reactions, anorexia nervosa, enuresis, soiling, intractable cough, speech and voice problems, tics, learning disabilities, drug abuse, dermatologic problems, diabetes, and juvenile rheumatoid arthritis.6
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.9
A 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 (P < .001).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.14
Hypnosis for chronic 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.15 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.17
Hypnosis combined with other methods, such as acupuncture, is also acceptable for chronic pediatric pain. One trial conducted in 21 girls aged 6 to 18 years demonstrated that the treatment was not associated with adverse effects and resulted in substantial alleviation of both child- and parent-rated pain and anticipatory anxiety.18
Because of the lack of treatment specification, however, some authors suggest that hypnotizing children does not qualify as efficacious according to criteria for empirically supported therapies.19
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. Hypnosis might have serious adverse effects in vulnerable subjects and should be administered by appropriately trained and experienced health professionals.
References
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19. Milling LS, Costantino CA. Clinical hypnosis with children: first steps toward empirical support. Int J Clin Exp Hypn. 2000;48(2):113–37. [PubMed]
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Through brain-imaging technology, researchers are finding that clinical hypnotherapy significantly and consistently decreases the experience of chronic pain. Studies indicate that 75 percent of clinical and experimental participants with different types of pain can obtain substantial pain relief through hypnotherapy. Those patients who are most receptive to hypnotic suggestions receive the greatest and most lasting relief. People who are moderately responsive to hypnosis also show improvement. Another proven benefit of hypnotherapy is better overall outcomes for medical treatment and greater physiological stability. These benefits are increased when patients are motivated to use all of their treatment options to manage pain.
Well-controlled experiments have proven that clinical hypnotherapy for pain, called hypno-analgesia, decreases patients’ sensitivity to pain. Hypnotherapy works by enabling patients to alter the psychological components of their experience of pain. Hypnotherapy has proven to be especially beneficial for people living with cancer, fibromyalgia, headaches, backaches, temporal mandibular disorders, and mixed chronic pain.
Hypnotherapy produces significant reductions in ratings of pain, need for sedation or analgesics, nausea and vomiting, and length of stay in hospitals. During a session, a hypnotherapist might tell an arthritis patient that he or she can turn down the experience of pain in a way similar to turning down the volume on a radio. This process returns a sense of control to the patient who might have felt out of control due to the chronic pain. Hypnotherapy generally is more effective than other pain-management interventions, such as education and physical therapy.
Although hypnotism may not cure the underlying cause of pain, it usually helps patients manage it. Researchers doing brain scans of chronic pain sufferers while in hypnotic trances found that the patients’ brains showed significantly reduced activity in the area of the brain responsible for the experience of pain. This indicates that hypnosis treatment works because it actually produces a physical effect on the brain. Other studies revealed that hypnotherapy could, at times, be even more effective than other pain relief methods.
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