Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review

Abstract

Objective Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children’s procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children’s procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader paediatric contexts. This scoping review maps the evidence of clinical hypnosis for children’s procedural pain and distress across broad paediatric contexts while highlighting knowledge gaps and areas requiring further investigation. Methods Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children’s procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children’s procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. Conclusion The review suggests potential benefits of clinical hypnosis for children’s procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.

Unlocking hypnotizability: Transcranial brain stimulation for enhanced impact in chronic pain

“… 2 Extensive research has underscored hypnosis’s efficacy across various psychological and somatic conditions, reporting high satisfaction levels, particularly in addressing stress, anxiety, and pain. 3 Studies have also delved into its effectiveness in managing acute procedural pain 4 and chronic musculoskeletal and neuropathic pain, 5 reflecting its broad applicability and therapeutic potential.…”

Primary States of Consciousness: A Review of Historical and Contemporary Developments

“…This can lead to the expression of emotions that are normally suppressed, as well as the ability to perform actions or engage in behaviors that are normally resisted (Brenman, Gill, and Hacker 1947). In this way, hypnosis can be seen as a loss of modularity between action, communication, and emotion, where patients will such as a comfortable chair or a quiet room, and techniques such as eye fixation or visualization to help the person focus their attention are all crucial elements (Geagea et al 2022;Robertson 2018). In addition to inducing a state of relaxation, hypnosis can also be used to help individuals explore hierarchical layers of cognition ordinarily beyond conscious access, to uncover the root causes of certain behaviors or emotional states (Putnam 1992).…”

“…Hypnosis is often used in therapy to help people overcome psychological barriers and induce behavioral change(Williamson 2019). It has been shown effective in treating a variety of conditions, including anxiety(Kılıç, Karadağ, and Tutar 2023), phobias(Wolf et al 2022), chronic pain(Geagea et al 2022) and post-traumatic stress disorder (D Spiegel and Cardena 1990)…”