Hypnosis and Burns


A number of studies have shown that hypnosis can reduce the pain experienced during a variety of medical conditions including burn-wound debridement, [1]. The International Journal of Clinical and Experimental Hypnosis found that hypnosis relieved the pain of 75% of 933 subjects participating in 27 different experiments.[2]

Hypnosis is effective in reducing pain from and coping with cancer and other chronic conditions. Nausea and other symptoms related to incurable diseases may also be managed with hypnosis.[3]

For some psychologists who uphold the altered state theory of hypnosis, pain relief in response to hypnosis is said to be the result of the brain’s dual-processing functionality. This effect is obtained either through the process of selective attention or dissociation, in which both theories involve the presence of activity in pain receptive regions of the brain, and a difference in the processing of the stimuli by the hypnotised subject.[4]

The American Psychological Association published a study comparing the effects of hypnosis, ordinary suggestion and placebo in reducing pain. The study found that highly suggestible individuals experienced a greater reduction in pain from hypnosis compared with placebo, whereas less suggestible subjects experienced no pain reduction from hypnosis when compared with placebo. Ordinary non-hypnotic suggestion also caused reduction in pain compared to placebo, but was able to reduce pain in a wider range of subjects (both high and low suggestible) than hypnosis. The results showed that it is primarily the subject’s responsiveness to suggestion, whether within the context of hypnosis or not, that is the main determinant of causing reduction in pain.[5]

Burns Table

Study 1: Hypnosis to Control Pain of Burn Patients
An Experimental Study of Hypnosis in Painful Burns
http://www.tandfonline.com/doi/abs/10.1080/00029157.1978.10403952#preview

Results: Both studies revealed significantly lower percentages of medication used (p < .01) by the hypnotic groups than control groups.

Notes: The present study examines the usefulness of hypnosis in the control of acute pain in thermal and electrically burned patients as an adjunctive analgesic during the routine care of burn wounds. It was hypothesized that the use of hypnosis would lead to significant reductions in the amount of drugs needed as compared to patients using medication only. Anxiety and discomfort associated with daily tanking, debridement, and dressing changes were expected to be reduced because of the introduction of hypnotic procedures. The experimental study also examined the variables of age and percent of burns. Two studies were conducted including patients with 0-30% total body burns and 31-60% burns. A variety of hypnotic techniques were used.

American Journal of Clinical Hypnosis. Vol 21(1), Jul 1978, 3-12
By: John R. Wakeman, Jerold Z. Kaplan, Department of Psychiatry, Brooke Army Medical Center, USA, U.S. Army Institute of Surgical Research, Brooke Army Medical Center, USA, Psychology Service, Department of Psychiatry, Brooke Army Medical Center, Fort Sam Houston, Texas, USA)

Study 2: Hypnosis to Control Pain During Burn Wound Debridement
Hypnosis for the treatment of burn pain
http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&uid=1993-06886-001

Results: Only hypnotized subjects reported significant pain reductions relative to pre-treatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain.

Notes: Investigated the clinical utility of hypnosis for controlling pain during wound debridement (removal of unhealthy tissue from a wound to promote healing). Thirty hospitalized burn patients and their nurses submitted visual analog scales (VASs) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day’s wound debridement, subjects received hypnosis, attention and information, or no treatment.

Journal of Consulting and Clinical Psychology, Vol 60(5), Oct 1992, 713-717
By: David R. Patterson, John J. Everett, G. Leonard Burns, Janet A. Marvin, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA

burns

Study 3: Hypnosis to Reduce Anxiety Before and During Dressing Changes of Burn Patients
Psychological approaches during dressing changes of burned patients: a prospective randomised study comparing hypnosis against stress reducing strategy
http://www.sciencedirect.com/science/article/pii/S0305417901000353

Results: The comparison of the two treatment groups indicated that VAS anxiety scores were significantly decreased before and during dressing changes when the hypnotic technique was used instead of stress reducing strategies (SRS).

Notes: A prospective study was designed to compare two psychological support interventions in controlling peri-dressing change pain and anxiety in severely burned patients. Thirty patients with a total burned surface area of 10-25%, requiring a hospital stay of at least 14 days, were randomized to receive either hypnosis or stress reducing strategies (SRS) adjunctively to routine intramuscular pre-dressing change analgesia and anxiolytic drugs. Visual analogue scale (VAS) scores for anxiety, pain, pain control and satisfaction were recorded at 2-day intervals throughout the 14-day study period, before, during and after dressing changes.

Burns, Volume 27, Issue 8, December 2001, Pages 793-799
By: Marie-Christine Frenay, Marie-Elisabeth Faymonville, Sabine Devlieger, Adelin Albert, Alain Vanderkelen, Burn Centre, Military Hospital Queen Astrid, Rue Bruyn, 1, 1120 Brussels, Belgium, Department of Anesthesiology, University Hospital, Liège, Belgium, Department of Biostatistics, University Hospital, Liège, Belgium

Study 4: Hypnosis for Pain in Severe Burn Patients
Hypnosis and pain in patients with severe burns: a pilot study
http://europepmc.org/abstract/MED/3228699

Results: Results show a 50-64 percent decrease in reported pain level for three patients and a 52 percent increase of pain for one patient. The mean decrease for these four patients was 30 percent (for overall as well as worst pain during dressing changes). A 30 percent reduction of anxiety level and a modest reduction of medication use were achieved concurrently. It is concluded that hypnosis is of potential value during dressing changes of burn patients.

Notes: This report presents a pilot study on the effectiveness of hypnosis in the control of pain during dressing changes of burn patients. Eight patients were treated, and all evaluated the interventions as beneficial. The treatment of four patients was more closely analyzed by obtaining pain and anxiety ratings daily.

Burns, Including Thermal Injury, 1988, 14(5):399-404
By: A. J. Van der Does, R. Van Dyck, R. E. Spijker, Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands

180px-Burn_Degree_Diagram

Study 5: Hypnosis for Burn Pain – Review of Six Studies
Medical hypnosis for pain and psychological distress during burn wound debridement: a critical review
http://www.oapublishinglondon.com/article/540

Results: The results of these studies suggest that hypnosis may be more effective than structured attention for reducing patients’ pain and anxiety levels during wound debridement. The existing evidence suggests that hypnosis may be effective in managing pain and distress for burn victims who have difficulty coping during wound debridement.

Notes: This article offers a critical review of the literature currently available on the efficacy of medical hypnosis for managing pain and distress during burn wound debridement. Six studies involving a total of 217 participants met inclusion criteria and are discussed in detail.

OA Alternative Medicine 2013 Apr 01;1(1):10
By: J. Sliwinski, W. Fisher, A. Johnson, G. Elkins, Baylor University Mind-Body Medicine Research Lab, Waco, Texas, USA

Additional References:

  1. Patterson, David R.; Questad, Kent A.; De Lateur, Barbara J. (1989). “Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement”. American Journal of Clinical Hypnosis 31 (3): 156–163.
  2. Nash, Michael R. “The Truth and the Hype of Hypnosis”. Scientific American: July 2001
  3. Kwekkeboom, K.L.; Gretarsdottir, E. (2006). “Systematic review of relaxation interventions for pain”. Journal of Nursing Scholarship 38 (3): 269–277.
  4. Myers, David G. (2014). Psychology: Tenth Edition in Modules (10th ed.). Worth Publishers. pp. 112–13.
  5. “Hypnosis, suggestion, and placebo in the reduction of experimental pain” faqs.org

Hypnosis and Bruxism (Teeth Grinding)


Bruxism is very common, particularly in conjunction with stress and anxiety and is often not recognised by the individual for lengthy periods of time. Many times it is not until someone else tells them to stop grinding their teeth, that a person becomes aware of it.

This unconsciously driven habit, as they all are, is very amenable to treatment by hypnosis because of the unconscious nature and the ability for hypnosis to access the unconscious enabling patients/clients, with guidance, to resolve the reasons behind the Bruxism.

As always you are free to make up your own mind after reading the research below.

Bruxism

Study 1: Case Study – Hypnosis Helps Nocturnal Bruxism
Nocturnal Bruxism and Hypnotherapy: A Case Study
http://www.tandfonline.com/doi/abs/10.1080/00207144.2013.753832?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed#preview

Results: At the end of the 7 hypnotherapy sessions, the bruxism had disappeared. Follow-up 1 year later indicated that the bruxism had not returned, and the client had become more assertive in her relations with others and had more exploratory activities in her life directions. The latter had not been dealt with in therapy. Thus, there appeared to be a “ripple effect” of successful therapy from one part of her life into its other aspects.

Notes: This article describes a case study of a hypnotherapeutic treatment of nocturnal bruxism. The author saw the client for a total of 7 hypnotherapy sessions.
It seems that a third party obtained this full research article and provided more details at http://www.hypnotherapy-glasgow.net/index.php/glasgow-hypnotherapy-about-hypnotherapy/hypnotherapy-for-teeth-grinding-bruxism-in-glasgow/.

Some of those details are listed below.
The client had been bruxing for more than 20 years, only at night. The result had been a sore jaw most mornings and consistent sleep interruption. Hypnosis was focused around the following themes:

(a) Allowing herself to “let go” and to learn new things about herself. It was suggested that her “unconscious mind” (a metaphor, following Milton Erickson) would begin to learn new ways of acting in the world;

(b) Shedding old roles in life and old discomforts and pains. While she was in trance, it was suggested that her strategy in life so far had been conservational, in that she was protecting herself. She could now begin to adopt a strategy of being transformational. It was compared metaphorically to adding new rooms to an existing house; the central core of the house (herself) remains the same, while new rooms (representing new actions, new ways of looking at things, new ideas) undergo significant change. The same person grows and develops while remaining centrally the same. The phrase “growing and developing; developing and growing” was used;

(c) Making new connections among her thoughts, feelings, and actions as she grows and develops. It was suggested that these connections will go around, under, through, and over her walls, gradually crumbling them and making them more permeable and transparent. It was suggested that as she continues to grow and develop she will no longer need her old ways of coping and the discomfort to her mind and body (metaphorically the jaw pain) they have produced; and

(d) “Letting go” (multifaceted) – letting go of her fear and letting go of the pain in her jaw (phrased as discomfort). They were, it was suggested, elements of her past she has now outgrown.

About a year later after the hypnotherapy sessions, the client reported that the jaw pain had not returned. Furthermore, her relationship with her husband and especially her mother had continued to improve. She had even made plans to return to school for an advanced degree and said, “I don’t think I would have done that before.” The author noted that he usually avoids direct suggestions in hypnosis and instead uses metaphors and stories to avoid arousing resistance.
The International Journal of Clinical and Experimental Hypnosis. 2013

Apr;61:205-18
By: E. Thomas Dowd, Dept. of Psychology, Kent State University, Kent, Ohio

Study 2: Case Study – Hypnosis Helps Bruxism (Improvement Maintained Five Years After Hypnosis)
Understanding change: five-year follow-up of brief hypnotic treatment of chronic bruxism
http://www.ncbi.nlm.nih.gov/pubmed/8203355

Results: A woman with a 60-year history of bruxism became symptom-free using hypnosis. This case demonstrates how enduring change may occur. Follow-up assessments at 2, 3, and 5 years revealed that she continued to be symptom-free with her self-reports corroborated by her spouse and family dentist.

Notes: This paper describes the treatment of a 63-year-old woman with a 60-year history of nocturnal bruxism. Treatment included assessment, two psychotherapy sessions, including a paradoxical behavior prescription to reduce daytime worrying, hypnotic suggestions for control of nocturnal grinding, and reinforcement of the patient’s expectations for success.

Am J Clin Hypn. 1994 Apr;36(4):276-81
By: M. B. LaCrosse, Monroe Mental Health Center, Inc., Norfolk, NE

Study 3: Hypnosis Helps Nocturnal Bruxism and Related Facial Pain
Suggestive hypnotherapy for nocturnal bruxism: a pilot study
http://www.tandfonline.com/doi/abs/10.1080/00029157.1991.10402942#.UhqVYRavszI

Results: The bruxers showed a significant decrease in EMG activity; they also experienced less facial pain and their partners reported less bruxing noise immediately following treatment and after 4 to 36 months.

Notes: This study describes the use of suggestive hypnotherapy and looks at its effectiveness in treating bruxism. Eight subjects who reported bruxism with symptoms such as muscle pain and complaints of bruxing noise from sleep partners were accepted into the study. An objective baseline of the bruxing was established using a portable electromyogram (EMG) detector attached over the masseter muscle during sleep. Hypnotherapy was then employed. Both self-reports and posttreatment EMG recordings were used to evaluate the hypnotherapy. Long-term effects were evaluated by self-reports only.

American Journal of Clinical Hypnosis. 1991 Apr;33(4):248-53
By: J. H. Clarke, P. J. Reynolds

Study 4: Hypnosis for Temporomandibular Disorders (problems with the jaw, jaw joint and surrounding facial muscles)
Medical hypnosis for temporomandibular disorders: Treatment efficacy and medical utilization outcome
http://www.calmhorizon.co.uk/downloads/tmd-and-hypnosis.pdf

Results: Statistical analysis of this open trial suggests that medical hypnosis is a potentially valuable treatment modality for temporomandibular disorders (TMD). After hypnosis, patients reported a significant decrease in pain frequency (F [3, 87] = 14.79, P < .001), pain duration (F [3, 87] = 9.56, P < .001), and pain intensity (F [3, 87] = 15.08, P < .001), and an increase in daily functioning. Analysis suggests that their symptoms did not simply spontaneously improve, and that their treatment gains were maintained for 6 months after hypnosis treatment.

Notes: The aim of this study was to examine the effectiveness of medical hypnosis on reducing the pain symptoms of temporomandibular disorders (TMD).Twenty-eight patients who were recalcitrant to conservative treatment for TMD participated in a medical hypnosis treatment program and completed measures of their pain symptoms on 4 separate occasions: during wait list, before hypnotic treatment, after hypnotic treatment, and at a 6-month follow-up.

Hypnosis involved, typically with eye closure inductions, imagery to evoke relaxation, catalepsy of a limb, hypnotic-deepening techniques, metaphors to induce automatic or unconscious bodily responses, hypnotic analgesia and anesthesia, and suggestions that use muscle tension, pain, or both as a cue for automatic muscle relaxation. An example of this follows: “I will now give you a very powerful post-hypnotic suggestion… that should you ever feel any tension in your jaw… head… neck… or shoulders… that is related to your medical, dental condition… it will be an immediate signal and cue to you for your muscles to relax… you will immediately take 2 deep relaxing breaths… and envision the healing ball causing the muscles to immediately relax… let go… release the tension… numbing the entire area… and then absorbing… any remaining pain or discomfort in those areas… as those muscles relax some more… and that’s just fine… you may be consciously aware of carrying out this healing process… or maybe just simply aware of carrying this process out at an unconscious level… as those muscles let go of the tension immediately… and your healing continues… and you will be surprised to find that this process occurs even during your sleep… instructing you that your unconscious is protecting you whether you had realized it or not…” with the addition of posthypnotic suggestions for relapse prevention. At the end of each session, patients were instructed to practice daily self-hypnosis with audiotaped recordings of the hypnotic inductions.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:54-63
By: E. Simon, D. Lewis. Eric P. Simon, Ph.D., ABPP (Department of Psychology, Multi-Disciplinary Pain Clinic) and David M. Lewis, DDS, (Dept of Dentistry) Honolulu, Hawaii, Tripler Regional Medical Center and the University of Hawaii.