Clinical Hypnosis in Pain & Symptom Management in Children

Dr. SaadatBy Haleh Saadat, MD
Nationwide Children’s Hospital, Columbus, OH

The ability of the brain and body to adapt to acute and chronic stress is an increasingly important topic in scientific literature. The brain has an enormous impact on an individual’s physical and mental wellbeing by constantly sorting out information and engaging the neuroendocrine, autonomic and immune systems.1-2 Neuroscience is beginning to recognize the potential of brain plasticity after the early developmental period.

Chronic psychosocial stress and consequent physiological reaction can affect the individual’s wellbeing. Children are especially vulnerable to the negative effects of pain and anxiety. Pain in children is a multidimensional experience, which varies significantly based on child’s previous experience, personality, expectations and cognitive maturation.3,4 Psychological factors, such as anticipation and context have shown to be as important as the intensity of the stimulus in the experience of pain.5 Children often consider painful procedures to be the most difficult part of their illness. Neuroimaging studies have shown that the mere anticipation of a painful stimulus, in spite of the absence of direct physical stimulus, can activate various areas of the brain.6-8 It has been shown that it is the individual differences in the brain’s perception of the stressors that determines the body’s reactions, and in due course determines the vulnerability or resilience toward stress-related disorders.9-11

A multidisciplinary team approach in the treatment of pain that links the expertise and knowledge of several specialists (Pediatricians, Anesthesiologists, Psychologists, Nurses, child life specialists, etc.,) allows the development of an individual treatment plan and integration of the conventional medical interventions with the complementary approaches.


Hypnosis is one of the several methods that as an adjunct is considered to be effective in the management of variety of pain and other medical conditions. The American Psychological Association’s Division of Psychological Hypnosis defines hypnosis as a “therapeutic procedure in which a health professional makes suggestions that will help a patient experience post-hypnotic alterations in perception, sensation, emotion, thought, and/or behavior”.12

Hypnosis dates back several thousand years to the Greeks, Egyptians, and Persians. Dr. Milton Erickson and Dr. Ernest Hilgard were among the first investigators to utilize hypnosis in the United States. In 1958, The American Medical Association acknowledged hypnosis as a valuable tool in medical treatment.13 The National Institutes of Health Technology Assessment Panel recognized hypnosis as “a viable and effective intervention for alleviating pain with cancer and other chronic pain”, in 1996.14

Over the past few decades, hypnosis has been utilized in children undergoing painful medical treatments in the emergency room, during invasive diagnostic procedures such as bone marrow aspiration and lumbar puncture, and for the management of preoperative anxiety and post-operative pain. It has been used to treat pain associated with variety of chronic disorders, such as cancer, asthma, rheumatoid arthritis, migraine headache, cystic fibrosis, sickle cell disease, and burns.15-26 Several studies have also shown improvement with use of hypnosis in children and adolescents who suffered from behavioral conditions such as enuresis, and dysphasia, Tourette syndrome, trichotillomania, thumb-sucking, and dysphasia.27-32 The advancement of brain imaging techniques has shown that hypnosis can effectively alter or modify several aspects of the person’s psychological, physiological and neurological function.33-38 In addition, these imaging techniques have revealed that the modulation of pain by hypnosis is different from relaxation, cognitive coping, or a placebo-like mechanism.39

Hypnosis can be easily integrated in routine pediatric practice.40 Children’s vivid imaginations, their desire to learn, and the ease with which they intertwine fantasy and reality makes them great subjects for the use of hypnosis.41-42 A typical hypnosis session in adults and adolescents consists of induction, deepening of the trance state, delivery of specific suggestions and finally re-emergence. The induction phase helps focus the patient’s attention. The length and the manner that one achieves this phase in children varies according to the nature of the problem, the child’s developmental age, learning style, interests and strengths. Children respond to a large variety of hypnotic induction techniques. These methods and strategies include eye fixation and guided imagery, visual images of a favorite place, auditory images of a favorite song or movement images such as a flying blanket or sport activity. Additional techniques include story telling, idiomotor activities such as arm levitation and progressive muscle relaxation. Teaching self-hypnosis is the crucial part of the session. Encouraging the child to practice the learned skill is fundamental to a successful outcome because it would give them a sense of control and mastery. Parental cooperation, and that of the pain management team, are essential in achieving success.

The National Pediatric Hypnosis Training Institute (NPHTI)43 is the organization that provides education and skill development in clinical hypnosis and hypnotherapy for health care professionals who work in pediatric settings. They offer workshops in introductory, intermediate, and advanced pediatric hypnosis.

In summary, hypnosis is a reliable method as an adjunct to the conventional medicine in the management of acute, chronic, procedural pain as well as many other conditions in some children. Further evidence-based trials needed to address issues related to the optimal timing and length of hypnotic interventions.


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