A Randomised Controlled Trial Investigating Medical Hypnosis for Faster Healing & Pain Reduction in Children Following Burn Injury

Burns and associated wound care procedures are painful and distressing for children. In addition to being painful, burn injuries can also result in severe psychological distress. Previous research has indicated that a reciprocal relationship may exist between symptoms of psychological distress and burn pain. Thus, treatment options that alleviate distress in both symptom areas must be offered to patients in order to optimize care. However, this proves difficult in clinical practice because many patients indicate that dressing changes and mechanical debridement (i.e. cleaning/removal of dead tissue) of burn wounds are in fact more painful than the original burn insult, provoking intense anticipatory anxiety. To prepare patients for burn wound care procedures a variety of pharmacological analgesia protocols are employed. Non-pharmacological techniques such as medical hypnosis are used as an adjunct to pharmacological methods for control of pain and anxiety. Importantly, a reduction in pain during burn wound care procedures has a demonstrated improvement in rate of re-­epithelialisation, an essential component of wound-healing. Medical hypnosis helps patients focus their awareness and attention to lessen pain and anxiety and encourage faster wound-healing. The technique has been demonstrated to decrease pain and anxiety in the short-­term and decrease psychological distress over the long-term, thereby optimizing patient outcomes and complementing existing treatment modalities. A hypnotherapist is a healthcare worker trained to use medical hypnosis, a technique used to naturally guide patients into a trance state which allows them to process information, including pain sensation, differently from how it is processed in the regular alert state. The patient is guided into trance by listening to the words of the hypnotherapist and following their instructions; patients can also be taught self-hypnosis which allows them to enter trance by themselves. As a therapeutic tool, medical hypnosis can help patients decrease their pain and anxiety levels by becoming more comfortable and relaxed, in addition to other significant psychological, physiological, and behavioral benefits. In our study, patients in the experimental group will receive hypnotherapy in addition to standard care (i.e. standard analgesia and wound care procedures). A maximum of 5 hypnotherapy sessions will take place, depending on the time it takes the burn wound to heal (i.e. >95% re-­epithelialisation). During each session, the patient will be guided into trance using hypnosis at the start of their burn wound care procedure (either their first application of dressings OR a subsequent dressing change, depending on their initial presentation to our Burns Unit). Each hypnotherapy session will last for the entire duration of the wound care procedure and will end after the new dressings are in place.