Uses of Hypnosis in Pediatric Anesthesia and Pediatric Headaches: A Literature Review

BACKGROUND: Managing pain and anxiety is a significant challenge for pediatricians. Infants, children, and teenagers - especially those with severe needle phobia -- can experience significant degrees of stress and anxiety prior to and after surgery, and during vaccinations or venipunctures. Headaches and migraines - another significant source of pain and anxiety for children and adolescents - can be difficult to treat with conventional pharmaceutical approaches. Hypnotherapy, or the use of hypnosis to achieve a therapeutic outcome, has a long history of providing some degree of somatic analgesia and anxiolysis. OBJECTIVE: The objective of this study is to critically review the literature dealing with hypnosis as a therapeutic tool in pediatric anesthesia and pediatric headaches. METHODS: A large database of medical and psychological publications (PubMed) was searched for studies in which hypnosis was used either for pediatric anesthesia/analgesia or for pediatric headaches. Those studies were then manually curated for their pertinence to hypnosis and pediatrics. They were subsequently classified according to the level of evidence that they provide in favor of hypnosis as a treatment modality. RESULTS: At this time, there is a relatively strong literature arguing in favor of hypnosis for peri-procedural pain relief and anxiolysis. There is limited evidence, however, to suggest that hypnosis can or should be used in scenarios that normally require general anesthesia. While there is increasing evidence to suggest a role for hypnosis in the management of recurrent headaches in children, there is as yet little substantial evidence to suggest a role in migraine headaches, despite one promising study. CONCLUSION: Given the increased popularity of complementary and alternative medicine (CAM), hypnotherapy is likely to be increasingly incorporated into the repertoire of tools for managing pain, anxiety, and headaches, perhaps in combination with relaxation, mindfulness, and biofeedback approaches. Additional studies of hypnosis, in specific clinical settings such as immobilization for radiotherapy, ophthalmologic procedures, and migraine headaches are needed. A more standardized approach to hypnotic induction by the hypnosis community would allow for more rigorous studies and trials.