Children in acute pain are often the easiest patients to help with the use of hypnotic techniques because they are highly motivated to feel better, to re-establish a sense of control in their life, and to rid themselves of—or at least decrease—their discomfort. In an office, Emergency Room, urgent care centre, or even at an accident site it is important to speak to an injured or ill child in a manner at once reassuring, comforting and believable. Children in an emergency situation of acute pain are already in a spontaneous, negatively focused, hypnotic state, negative in its acutely focused concentration on the injury, the bleeding, and the fear that things will get worse (Kohen, 1986; Olness & Kohen, 1996; Kuttner, 1997). It is, therefore, that much more important that we choose our language of communication carefully, and modulate what we say and how we say it to foster attention toward positive feelings, expectations, and ultimately cooperation. When a clinician empathically tells an Emergency Room child-patient 'Whew ... that really hurts', this immediately identifies the clinician as a good observer, fosters the child's willingness and ability to pay attention to the clinician, and opens the opportunity for additional hypnotic suggestions toward relief: for example, 'I'm glad you came to the doctor, it will probably hurt less soon' or 'It will probably keep right on hurting until it doesn't need to anymore ... now that you're here and know you will be getting help ...'. Such positive 'reframing' expectations may then easily be reinforced by hypnotic strategies designed to allow the child to alter their perception of discomfort; for example, we might say 'Would it be okay to take your mind somewhere else?' or 'What will you do when you get home, after this is taken care of?' Beyond distraction, this query offers the reassurance to the child that s/he will be going home. Similarly, children in acute pain often easily accept direct 'permission' or suggestions to dissociate their pain; for example, 'Close your eyes ... find the switches in your mind that control discomfort... find the one for your leg ... What colour is it in your mind? ... What shape? Is it a turn or a flip or a slide kind of switch? Now, turn it down ... and then 1-2-3-click, off, and notice how different it feels ... nice going!' Adding relaxation, dissociation via leaving to a favourite place, or hypnoa-nesthesia or analgesia by cleaning the injured part with a 'special liquid that is cool and comforting' are additional strategies that may be useful, especially as they are tailored to the child's needs (Kohen & Olness, 1993; Olness & Koben, 1996).
For procedures such as injections, venipunctures for blood withdrawal or intravenous hookups, a bone marrow or spinal taps more time is usually available to plan treatment and hypnotic assistance. This allows for, and should include, a creative exploration of the techniques that may be of greatest benefit to a given child, and for rehearsal in preparation for the designated procedure. A myriad of pain (and anxiety) control methods with hypnosis (Olness & Kohen, 1996) might include:
1. Re-creating a feeling of numbness from memories of previous (local) anaesthesia.
2. Practising modulating discomfort through turning down a 'pain switch'.
3. Sending discomfort away by blowing it away in bubbles (literally and imaginatively) (Kuttner, 1986, 1988, 1997, 1999; Sugarman, 1997).
4. Imagining taking an adventure trip around the body to install a protective barrier to prevent the signal from the potential pain site from getting through to the mind. When the procedures are recurrent, and what is anticipated is predictably emotionally charged by the recalled pain from the previous procedure, adding hypnotic amnesia for the prior event may be very beneficial.
Memories of previous pain may dramatically affect a child's perceptions and behaviors with the next episode of some recurrent pain syndrome (e.g., recurrent abdominal pain, migraines, inflammatory bowel disease, etc.) or in association with their chronic illness. As with biobehavioral problems, the application of hypnosis in management of chronic or recurrent pain in children and adolescents is best viewed and understood as one strategy within a comprehensive pain management programme tailored to the child's personal, individual needs (Kuttner, 1999).
Was this article helpful?
Hypnosis has been defined as a state of heightened suggestibility in which the subject is able to uncritically accept ideas for self-improvement and act on them appropriately. When a hypnotist hypnotizes his subject, it is known as hetero-hypnosis. When an individual puts himself into a state of hypnosis, it is known as self-hypnosis.