Hypnosis reduces pain and anxiety in children with acute burn injuries: A randomized controlled trial

Abstract

Background: Nonpharmacologic interventions are critical for pain and anxiety management in pediatric burns and are linked with improved healing rates. Although medical hypnosis (hypnotherapy) is effective for decreasing pain and anxiety in adult burns and during painful pediatric procedures, no randomized controlled trial (RCT) has investigated hypnotherapy for pediatric burns. This RCT aimed to determine if hypnotherapy decreases children's pain, anxiety, and stress during wound care procedures and accelerates wound healing. Methods: Children (4-16 years) with acute burns presenting for their first dressing change were randomly assigned to either group 1, the experimental group (hypnotherapy), or group 2, the control group (standard care). Repeated measures of pain intensity, anxiety, stress, and wound healing were taken at every dressing change until 95% wound reepithelialization. Results: Data for 62 children were analyzed on an intent-to-treat basis using generalized estimating equations (n=35 standard group, n=27 hypnotherapy group). The hypnotherapy group self-reported pain scores that were significantly lower on a 0-10 scale than the standard care group scores prior to dressing change number 2 (mean difference=-1.37; 95% confidence interval [CI]-2.61,-0.12; P=0.03) and number 3 (mean difference=-1.33; 95% CI-2.53,-0.13; P=0.03). Across all dressing changes, parent-reported maximum pain intensity scores for the hypnotherapy group were significantly lower (mean difference=-1.16; 95% CI-2.31,-0.01; P=0.048). Prior to the second dressing change, the hypnotherapy group also reported significantly lower anxiety scores (mean difference=-1.11; 95% CI-1.99,-0.22; P=0.01) on a visual analog scale compared to standard care. At the third dressing change, the hypnotherapy group had significantly lower heart rates (bpm) preprocedure (mean difference=-18.50; 95% CI-31.93,-5.07; P=0.01) and postprocedure (mean difference=-18.08; 95% CI-33.86,-2.30; P=0.03). No adverse events occurred in either group. Conclusion: Hypnotherapy appears to be effective for decreasing pain, preprocedural anxiety, and stress during pediatric wound care procedures.L6213531582018-03-27 <br />