Hypnotherapy for Pain, Itch and Anxiety in Burned Children: A feasibility and effectiveness study

Face-to-face hypnotherapy interventions will be delivered individually for children with acute burns during their visits to the burns centre at the hospital for dressing changes. The provider of the interventions is a certified hypnotherapist with more than 8 years of experience in conducting hypnotherapy with children from diverse backgrounds with a range of conditions involving pain and distress in therapeutic and medical settings. During the first visit, the intervention will involve a pre-hypnosis interview provided before medication intake, hypnotic suggestibility test (i.e., standard induction of hypnosis and test suggestions) starting right before the dressing change; followed by therapeutic suggestions for pain and anxiety before emergence from hypnosis. The intervention during the first visit will last up for 45 minutes and involves a pre-hypnosis interview for up to 10 minutes, a hypnotic suggestibility test for 20 minutes and suggestions for up to 15 minutes. In the following visits, hypnotherapy interventions will consist of hypnotherapy sessions provided as described in the intervention manual that was specifically developed for procedural pain, state anxiety and itch in children with burns and that can be obtained upon request. A hypnotherapy session involves induction and deepening of hypnosis followed by therapeutic suggestions before emerging from hypnosis. Hypnotherapy sessions will start right before removing the dressing change and end when the new dressing is applied and thus will have the same duration as dressing changes, which is between 20 and 35 minutes. A maximum of five interventions will be provided for children on their weekly hospital visits for dressing changes over five weeks until their burns heal. Following the delivery of the initial intervention, children will be provided with a taped recording of instructions for self-hypnosis to reduce the time needed to teach them self-hypnosis. Children will be asked to practice self-hypnosis for 20 minutes daily during their participation in the study for up to five weeks. The hypnotherapist will adhere to the manual in delivering core elements of the intervention as assessed by a fidelity completion of intervention checklist to facilitate replication and target procedural pain, state anxiety and itch. The intervention will be tailored and adapted as informed by the pre-hypnosis interview and suggestibility screening to account for the hypnotherapist’s style as well as influencing factors of hypnotic responsiveness and pain (e.g., child-related factors, contextual factors related to the acute hospital setting involving parents and clinicians). Pre-recorded music will accompany all hypnotherapy sessions. Hypnotherapy will be provided as an adjunct to pain medications that will be administered orally 20 minutes before the dressing changes in specific dosages, as determined by body weight: oxycodone 0.1 mg/kg, Paracetamol 150 mg/kg, Ibuprofen 10mg/kg. Active (e.g., interactive toys including video games, virtual reality devices, controlled breathing, guided imagery) and passive distraction techniques (e.g., passive music, videos on a portable device) will also be used as part of standard pre or post-procedural care.