Hypnosis to Reduce Distress in Children Undergoing Anorectal Manometry: A Randomized Controlled Pilot Trial

Abstract

Background/AimsTo assess the effectiveness and feasibility of a brief session of hypnosis to reduce distress in children with functional constipation undergoing anorectal manometry (ARM). MethodsA partially-blinded randomized controlled pilot trial was conducted in children 4-18 years old scheduled for ARM. Children were randomized to receive a brief session of hypnosis prior to ARM or standard care. Non-blinded and blinded observers rated the child's level of distress using the Observation Scale of Behavioral Distress and a 4-point-Likert scale, respectively. Differences between groups were analyzed using Fisher's exact test or Mann-Whitney U test as appropriate. ResultsData from 32 children (15 hypnosis and 17 standard care) were analyzed. Prior to insertion of the catheter, the observed mean levels of distress were lower in the hypnosis group according to both the non-blinded observer (median 0.0 [interquartile range {IQR} 0.0-0.3] vs 1.4 ]; P = 0.009) and the blinded observer (median 0.0 [IQR 0.0-0.0] vs 0.5 [IQR 0.0-1.0]; P = 0.044). During ARM, observed and reported levels of distress did not differ significantly. In the hypnosis group, 92.9% of parents and children reported that hypnosis helped the child to relax. There were no significant differences in resting pressure, squeeze pressure, or duration of the procedure between both groups. ConclusionA brief session of hypnosis for children before ARM is an easily incorporable intervention that lowers distress levels prior to the procedure and is positively perceived by children and parents.

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

“…Pain and distress-related outcomes were mainly pain intensity and indicators (e.g., analgesic requirements), as well as distress-related constructs, such as behavioral distress, anxiety, fear, stress biomarkers (blood pressure, heart rate), discomfort, satisfaction, and anxiolytics requirements. Most studies (76%) involved multiple assessors, including children, parents, and observers (13%) [ 45 , 74 , 81 , 103 , 108 ]; children and parents (5%) [ 84 , 105 ]; children and observers (55%) [ 72 , 75 , 76 , 78 , 83 , 85 , 86 , 88 , 91–93 , 95–100 , 102 , 104 , 106 , 107 ]; parents and observers (3%) [ 87 ]. A few studies involved single assessors entailing observers (18%) [ 73 , 79 , 80 , 82 , 89 , 90 , 101 ] or children (3%) [ 77 ].…”

“…An observational study reported tolerability, willingness to repeat the procedure, satisfaction, anxiety, and low pain with clinical hypnosis alone or combined with sedatives (midazolam and inhaled anesthetics) [ 76 ]. Clinical hypnosis across RCTs was significantly superior to standard care [ 72 , 80 , 81 , 85 , 86 , 96 , 102 , 108 ]; distraction [ 86 , 103 ]; control [ 73 , 106 ]; acupressure and audio-visual aids [ 73 ]; play [ 93 ]; support and attention control [ 105 ]. Despite lower parental treatment days and doses with clinical hypnosis, oral analgesics requirements were higher in an RCT due to earlier discharge [ 101 ].…”

“…Several studies (39%) did not report on factors influencing the pain and/or distress outcomes of clinical hypnosis [ 73 , 74 , 81–85 , 87–89 , 92 , 94 , 96 , 100 , 104 , 106 ]. Reported influencing factors included intervention timing (e.g., during subsequent procedure), hypnotherapist’s presence (e.g., hetero or self-hypnosis), child baseline and procedural distress or anxiety, chemotherapy-induced emesis (i.e., vomiting process), rapport with the hypnotherapist, and parents’ distress-promoting behavior ( Table 5 ) [ 45 , 72 , 77 , 78 , 91 , 93 , 98 , 99 , 105 , 107 ].…”

“…Rates of refusal to participate reported in 42% of studies were between 0% and 52% [ 76 , 78 , 81 , 82 , 85 , 92 , 96–100 , 102 , 105–108 ]. Parents refused participation for the reasons of thinking that hypnotic discussion or training would bring undo attention to medical procedures and increase children’s anxiety [ 107 ], not wanting a reminder of the illness, or claiming that children had no problem [ 105 ].…”

Hypnotherapy in Pediatric Gastroenterology

“…A recent pilot randomized controlled trial assessed the effectiveness and feasibility of a brief hypnosis session to reduce distress in children with functional constipation undergoing anorectal manometry. The authors concluded that one hypnosis session for children before the procedure is an easily incorporable intervention that lowers distress levels before anorectal manometry and is positively perceived by children and parents (49). Also a prospective single‐center study in 140 children older than 6 years requiring a diagnostic esophagogastroduodenoscopy or rectosigmoidoscopy suggests that hypnosis combined with oxygen and nitrous oxide and/or midazolam is of additional value to perform diagnostic esophagogastroduodenoscopy or rectosigmoidoscopy without systematic need for general anesthesia (50).…”