Authors: Dali Geagea, Zephanie Tyack, Roy Kimble, Vince Polito, Bassel Ayoub, Devin B Terhune, Bronwyn Griffin
Categories: Psychology, Psychiatry & Brain Neuroscience Section, Children, Clinical Hypnosis, Distress, Procedural Pain, Scoping Review, AcademicSubjects/MED00010
Source: Pain Medicine: The Official Journal of the American Academy of Pain Medicine
Doi: 10.1093/pm/pnac186
Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children’s procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children’s procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children’s procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation.
Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children’s procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children’s procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated.
The review suggests potential benefits of clinical hypnosis for children’s procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.
Keywords: Procedural Pain, Distress, Clinical Hypnosis, Children, Scoping Review
Acute distress and pain are commonly experienced by children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments. Distress involves physiological (e.g., increased blood pressure and pulse), behavioral (e.g., aggressivity), and psychological (e.g., fear, anxiety) changes in response to procedures that are perceived as unpleasant stimuli [1–3]. Pain refers to “an unpleasant experience associated with or resembling that associated with actual or potential tissue damage with sensory (e.g., intensity, severity), emotional (e.g., unpleasantness), cognitive (e.g., perceptions), and social components” [4, 5]. Inadequately treated procedural pain and distress can exacerbate each other, amplify inflammation, delay recovery, and reduce compliance, which can extend hospitalization and increase medications’ requirements [6–12]. Inadequately treated procedural pain and distress can also cause chronic biopsychosocial impairments (e.g., social withdrawal, school problems, sleep disturbance, and chronic stress) that can negatively affect children’s quality of life, psychological well-being, family, and subsequent pain management [9, 13, 14]. The adequate treatment of children’s procedural pain and distress is a fundamental human right and is required to alleviate biopsychosocial impairments and their impact on children and families in addition to improving children’s well-being, healthcare, and recovery [7, 12, 15, 16].
Notwithstanding healthcare and research progresses, procedural pain and distress have been inadequately treated in more than half of hospitalized children [17, 18]. Despite popularity and benefits, pain and distress medications are limited by side effects, high expenses, potential ineffectiveness, contraindications, inability to address all components of pain, as well as lack of tailoring and consensus regarding effective doses and regimens [19–22]. Thus, treating children’s procedural pain and distress needs improvement in line with pediatric pain guidelines [23]. Effective, safe, and tailored psychological adjuncts to medications can optimize treating children’s procedural pain and distress by targeting cognitive and emotional pain determinants while reducing concerns over medications’ safety, addictive properties, and costs [24].
Clinical hypnosis is a safe and tailored psychological intervention with potential benefits and a long history of use in children undergoing painful procedures [25]. Clinical hypnosis mainly consists of an induction in a specific sociocultural context followed by suggestions eliciting varied sensory, cognitive-perceptual, and/or behavioral alterations for therapeutic purposes [26]. Although research on clinical hypnosis has been primarily conducted in adults, children’s higher hypnotic responsiveness, strong imagination, and motivation to learn new skills can make them more receptive to hypnosis than adults [25, 27]. Consistently, a meta-analysis of 28 studies on clinical hypnosis for procedural distress reported larger effect sizes in children in comparison to adults [28]. Furthermore, the effectiveness of clinical hypnosis for children’s procedural pain is supported by systematic evidence of superiority (medium to large effect) to standard care, control conditions, and other psychological interventions in children [17, 18, 29–36]. Clinical hypnosis can be tailored to diverse settings and populations as well as delivered in varied modes and durations, which facilitates its application [28, 37]. Thus, clinical hypnosis may be promising for children’s procedural pain and distress due to safety, adaptability, evidence of effectiveness, and wide clinical use [25].
Despite evidence suggesting the effectiveness of clinical hypnosis for children’s procedural pain and distress, research is lacking in the broader contexts of children undergoing painful medical procedures. Systematic reviews of clinical hypnosis for children’s procedural pain have focused on needle-related and oncology procedures, disregarding other medical contexts. Furthermore, based on a scoping review of systematic reviews, clinical hypnosis has not been systematically reviewed in the broad context of pediatric procedural pain and distress within the last 10 years [38]. Hence, a review of recent studies on clinical hypnosis for procedural pain and distress in broader pediatric contexts is warranted.
Furthermore, despite supporting the effectiveness of clinical hypnosis for children’s procedural pain and distress, systematic reviews have inadequately reported areas with relevance to research conduct and intervention delivery. First, mapping evidence on interventions is warranted to reduce the bias of inadequately reporting hypnotic components, enhance the understanding of clinical hypnosis, and guide treatment delivery and tailoring [36, 39, 40]. Second, factors that can influence the implementation and outcomes of clinical hypnosis have not been adequately reported and thus require further examinations that follow interventional and implementation research guidelines [18, 27, 29, 31, 35–37, 39–42]. Third, reviews have mainly investigated the effectiveness of clinical hypnosis for pain intensity in children, omitting other components of pain that warrant examination, such as pain unpleasantness [32, 33, 35, 36, 43–45]. Fourth, data on the safety of clinical hypnosis have been reported in both adult and children’s studies (e.g., [29, 45, 46]) but are lacking in systematic reviews of clinical hypnosis for children’s procedural pain and distress [17, 18, 30–36]. Mapping evidence on the safety of clinical hypnosis is important to ensure the protection of children and assist clinical decision making. Furthermore, despite their important and increasing use to guide study conduct and justify research significance, theoretical frameworks remain inadequately reported [47]. Thus, mapping evidence on areas relevant to clinical hypnosis research and intervention delivery, including interventions, influencing factors, safety, and theoretical frameworks, is warranted.
Whereas systematic reviews appraise and synthesize evidence to address specific research questions, scoping reviews broadly map the scope and nature of evidence to specify research gaps and areas requiring further investigation [48, 49]. Thus, scoping reviews are useful precursors to systematic reviews and trials, which allows the targeting of research funding to areas with a paucity of experimental research [50]. Two scoping reviews of clinical hypnosis for pain have been published to date, entailing a review examining chronic neuropathic pain while disregarding acute procedural pain [51] and a review mapping recent systematic reviews from 2014 [38]. The latter review included only a single systematic review on clinical hypnosis for children’s procedural pain [52]. Both reviews did not map evidence on areas with relevance to clinical hypnosis research entailing adverse effects, distress and pain unpleasantness outcomes, influencing factors, as well as barriers and facilitators to implementing hypnosis and study procedures. This scoping review is conducted to address this paucity of knowledge.
The overall aims of this review were to map the scope and nature of available evidence on clinical hypnosis for children’s procedural pain and distress, explore areas relevant to research conduct and intervention delivery, and identify knowledge gaps to guide future studies and systematic reviews.
The specific aims of the review were to summarize evidence on clinical hypnosis pain and distress outcomes (e.g., pain unpleasantness and intensity) with their measurement methods and time-points as well as related perceived and actual influencing factors, including hypnotic suggestibility; barriers and facilitators to implementing hypnosis and study procedures; the safety of clinical hypnosis; interventions’ characteristics (e.g., components, duration, provider, treatment manual, delivery mode, the fidelity of delivery); and theoretical frameworks guiding the study design, intervention reporting, barriers and facilitators, collection, analysis, interpretation, and dissemination of data. Although evaluating the quality of evidence and effectiveness is beyond the scope of this review, the effects of clinical hypnosis were reported to identify potentially relevant outcomes and underpin systematic reviews at the preliminary and evidence-based scoping stage [49].
To ensure transparency and accuracy, the scoping review follows the recommendations of Arksey and O'Malley [53] and Joanna Briggs Institute (JBI) [54]. Data charting and reporting are in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) [55] and JBI [54] guidelines. Population, Concept, and Context (PCC) elements were used to guide the scoping review (e.g., eligibility criteria, research questions, data charting, and data synthesis) [54]. For transparent data reporting and to avoid publication bias, a protocol detailing the conduct of the scoping review was published [56].
Research questions were developed following a preliminary review of the systematic evidence of clinical hypnosis for children’s procedural pain and distress in line with the objectives of the scoping review.
Articles’ eligibility was evaluated based on research questions as mapped to PCC elements and study characteristics [54].
Studies including participants under 18 years were considered for inclusion in line with the United Nations’ definition of children and systematic reviews of clinical hypnosis for children’s procedural pain and distress [33, 52, 57, 58]. Studies including both adults and children were considered for inclusion only if children’s outcomes were analyzed or reported separately.
** Clinical hypnosis interventions:** Clinical hypnosis comprises an induction followed by therapeutic suggestions eliciting sensory, cognitive-perceptual, affective and/or behavioral alterations [25, 59]. Inductions typically involve describing the procedure as hypnosis followed by instructions for relaxation, receptiveness to suggestions, and attention focused on external objects (eye-fixation) and/or internal experiences (pleasant imagery) [59]. Suggestions entail invitations to perform motor and/or cognitive actions to elicit changes in emotions, cognitions, perceptions, sensations, and/or behaviors experienced during or beyond hypnosis [25]. In clinical hypnosis, therapeutic suggestions are provided to alleviate symptoms or promote desired therapy outcomes. Studies were considered for inclusion if they examined an intervention labelled as clinical hypnosis or a close synonym (e.g., hypnosis, hypnotherapy) or met the criteria to be qualified as clinical hypnosis based on literature [26]. Accordingly, studies examining interventions involving essential clinical hypnosis components (i.e., at least an induction element and suggestions for pain and/or distress) were considered for inclusion [60–62].
** Procedural pain and distress outcomes:** Studies examining procedure-related (pre, post, or intra-procedural) distress and/or pain outcomes (e.g., pain intensity and/or unpleasantness) or markers (e.g., analgesics doses, satisfaction, comfort) were considered for inclusion, except studies examining solely physiological measures of pain and/or distress (e.g., heart rate) [63, 64].
Studies conducted in a medical context or examining pain related to medical procedures, implying a medical context, were considered for inclusion. Studies on experimental pain were excluded as they involve nociception, that is distinct from pain elicited by medical procedures, and are conducted in non-medical contexts.
** Time:** For a comprehensive review of recent and older relevant articles and to obtain the historical context of clinical hypnosis, the review was not limited in scope based on publication time.
** Source:** In addition to peer-reviewed journal articles, grey literature that includes unpublished data that is more likely to include negative findings related to feasibility, acceptability (including safety), and effectiveness was considered for inclusion [65]. Including grey literature aimed to broaden the scope of the review as well as reduce study selection and publication bias by providing a more comprehensive review of the available evidence [65]. Conference proceedings and abstracts were considered for inclusion if they included sufficient data for extraction.
** Language:** For broader research capture, no language limitation was used for abstract and title screening. Full-text articles in Arabic, English, French, German, Italian, and Spanish were considered for inclusion as the first author is fluent in these languages.
** Design:** For a comprehensive overview of research to date, studies were considered for inclusion irrespective of design (e.g., retrospective, observational, and pre-post designs) except case studies and case reports that comprise individual reports and are thus less generalizable [66]. Review articles were excluded after checking their references to avoid duplication of information.
Published and grey literature on clinical hypnosis for children’s procedural pain and distress were searched using keywords and index terms identified in the initial search (variations of the terms hypnosis/hypnotherapy, child, pain, and distress) (Supplementary Data File 1) [56]. Databases searched included CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Web of Science. Searched grey literature included BioRxiv, ClinicalTrials.gov, MedRxiv, Open Grey, Open Science Framework, the Australian New Zealand Clinical Trials Registry, and the American Psychological Association website (apa.org). All records up to May 2022 were included (the date last searched was November 5, 2022). To locate additional articles that might not have been captured in database searches, references of included papers and relevant systematic reviews were screened followed by hand-searching a key hypnosis journal entitled the International Journal of Experimental and Clinical Hypnosis [53].
References found in searches were added to EndnoteX9^®^ referencing software (Clarivate Analytics, Philadelphia, USA) where duplicates were removed by automation. After removing duplicates, to ensure transparent data management during study selection, search results were uploaded to Covidence^®^ software (Veritas Health Innovation, Melbourne, Australia; available at www.covidence.org) where further duplicates were removed by automation [67]. Two reviewers (D.G. and B.A.) independently screened titles and abstracts to identify relevant studies for full-text screening using Covidence^®^. Studies were selected for full-text review or excluded if both reviewers agreed. Disputes in eligibility screening were resolved by full-text retrieval and review. In the absence of access to articles, corresponding authors were contacted to provide access. When full texts were not found, corresponding abstracts were used to extract relevant information if they contained sufficient information to enable assessing the articles’ eligibility and extracting data. Two reviewers (D.G. and B.A.) independently screened full texts of selected studies using Covidence^®^ [67]. In the case of disagreements regarding the selection of studies, other reviewers (B.G. and Z.T.) were consulted to discuss the eligibility of the studies in question until reaching a consensus. For full texts involving interventions not labelled as hypnosis/hypnotherapy, a reviewer (V.P.) with expertise in theoretical hypnosis was consulted to evaluate if the interventions met the eligibility criteria to be qualified as clinical hypnosis. Further duplicates and studies with identical data sets were removed during full-text screening by manual checking. A PRISMA flow diagram (Figure 1) illustrates the selection process and the flow of papers included and excluded at each stage [68].
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for literature search and selection.
Authors created a charting form to record data, including characteristics of studies, populations, interventions, and outcomes, as relevant to the review questions (Supplementary Data File 2) [56]. Two reviewers (D.G. and B.A.) independently charted and piloted 20% of the results following a discussion with a third reviewer (B.G.). Piloting the extracted data form led to alterations in consultation with a fourth reviewer (Z.T.) to ensure a logical and descriptive summary covering all relevant information [54]. The developed charting table was adjusted based on the supplementary extracted information to include more categories and chart headings following a discussion with two other authors (D.T. and V.P.). The remaining data was extracted by a reviewer (D.G.) and checked by a second reviewer (B.G.). Based on the review objectives, only outcomes related to pain and distress (e.g., distress constructs of anxiety, fear, discomfort, and physiological stress) were extracted [69]. In the absence of information on assessors of outcomes, medical records were considered as reported by observers, as these records are usually collected by medical staff, not parents or children. The Template for Intervention Description and Replication (TIDieR) framework was used to guide extracting data on interventions [40]. Barriers and facilitators to implementing hypnosis and study procedures were mapped to the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework [70]. After contacting the primary authors of included studies to provide or confirm information, missing data were recorded as such if not provided.
Extracted quantitative and qualitative data were summarized and presented in tables accompanied by a narrative synthesis [54, 55]. These data included publication year, author, design, context, population, interventions, barriers and facilitators to implementing hypnosis and study procedures, pain and distress-related outcomes, the safety of clinical hypnosis, and factors influencing outcomes (Supplementary Data File 2). The correlation of factors with outcomes was considered weak or strong based on authors’ reporting of effects’ significance (e.g., F and t-tests) and Cohen’s thresholds for correlation strengths (Pearson’s r 0.10, 0.30, and 0.50, respectively, considered weak, moderate, and strong [71]).
Thirty-eight studies investigating clinical hypnosis for children’s procedural pain and/or distress were included. Characteristics of included studies are summarized in Table 1 and detailed in Table 2. All studies were published in English between 1975 and 2022, with 39% published since 2010 (Figure 2) [45, 72–85]. Studies were conducted predominantly in North America and Europe (Figure 3, Table 2). Studies were published mainly as journal articles except for a conference abstract and three dissertations. Most included studies used controlled designs (76%) that were predominantly prospective (71%) and randomized (68%), except two controlled retrospective studies (5%) (Table 1). No models, theories, or frameworks for study design or collection, analysis, interpretation, and dissemination of data were reported except in a study in which participants’ age range (3–10 years) was based on Piaget’s cognitive theory (Table 1). According to this theory, age is inversely linked to anxiety, in that younger children (3–6 years) display more behavioral and physical distress than older children [86].
Figure 2. Number of included studies per decade.
Figure 3. Percentage of included studies per country.
Only three studies (8%) reported on the safety of clinical hypnosis, with all indicating the absence of adverse effects [45, 89, 101]. Pain and distress-related outcomes of clinical hypnosis examined across studies with corresponding assessment sources (assessors) and tools are detailed in Table 2. Pain and distress-related outcomes were mainly pain intensity and indicators (e.g., analgesic requirements), as well as distress-related constructs, such as behavioral distress, anxiety, fear, stress biomarkers (blood pressure, heart rate), discomfort, satisfaction, and anxiolytics requirements. Most studies (76%) involved multiple assessors, including children, parents, and observers (13%) [45, 74, 81, 103, 108]; children and parents (5%) [84, 105]; children and observers (55%) [72, 75, 76, 78, 83, 85, 86, 88, 91–93, 95–100, 102, 104, 106, 107]; parents and observers (3%) [87]. A few studies involved single assessors entailing observers (18%) [73, 79, 80, 82, 89, 90, 101] or children (3%) [77]. Assessors were unknown in a study examining procedural pain (3%) [94]. Data collection methods were mainly quantitative and included numeric scales for parent proxy reports; numeric and faces scales for children’s self-reports; numeric scales, medical records, as well as distress checklists and questionnaires for observer proxy reports.
Pain and distress-related outcomes of clinical hypnosis as a sole treatment are summarized in Table 3. Indirect and direct clinical hypnosis respectively entailing direct (e.g., instructions) or indirect (e.g., metaphors and analogies) suggestions were similarly effective [91]. Clinical hypnosis without comparators was linked to pain relief [95]. Three pre-post control studies [84, 92, 94] and a repeated measures study [77] reported a significant and non-significant superiority of clinical hypnosis vs baseline conditions. The effects of clinical hypnosis were also significantly and non-significantly superior to distraction in an observational study [74] and to standard care in two retrospective studies [78, 83]. An observational study reported tolerability, willingness to repeat the procedure, satisfaction, anxiety, and low pain with clinical hypnosis alone or combined with sedatives (midazolam and inhaled anesthetics) [76]. Clinical hypnosis across RCTs was significantly superior to standard care [72, 80, 81, 85, 86, 96, 102, 108]; distraction [86, 103]; control [73, 106]; acupressure and audio-visual aids [73]; play [93]; support and attention control [105]. Despite lower parental treatment days and doses with clinical hypnosis, oral analgesics requirements were higher in an RCT due to earlier discharge [101]. RCTs also reported that the effects of clinical hypnosis were non-significantly superior to active cognitive strategies [104], distraction [86], control [106], and progressive muscle relaxation [85], or similar to standard care [80, 107], counselling [107], and play [93].
Clinical hypnosis was also examined as an adjunct treatment without comparators in two observational studies [75, 88] or compared to standard care and psychological interventions in nine RCTs [45, 79, 82, 87, 89, 97–100] and a cross-over study [90] (Table 4). An observational study indicated the absence of procedural fear or panic and the reduced need for pain medications post-operatively when clinical hypnosis was combined with general anesthesia [88]. Another observational study showed relaxation and cooperation during procedures when clinical hypnosis was combined with midazolam [75]. Clinical hypnosis combined with placebo was as effective as standard pharmacological care for procedural pain and discomfort and significantly more effective for procedural anxiety and post-procedural behavioral disorders [87]. Clinical hypnosis as an adjunct to standard care yield similar (for procedural pain, post-procedural anxiety, and morphine use) or superior (non-significantly for post-procedural stress biomarkers, analgesics, and anxiolytics, or significantly for procedural anxiety) effects than standard care [45, 82, 89]. Clinical hypnosis with standard care was significantly superior to both standard care and cognitive behavioral therapy for procedural anxiety and behavioral distress, significantly superior to standard care and as effective as cognitive behavioral therapy for procedural pain [97]. When combined with standard care, direct and indirect clinical hypnosis were similarly effective and elicited significantly superior effects than standard care [98]. Clinical hypnosis as an adjunct to local anesthetics was significantly superior to local anesthetics alone or with attention control based on RCTs [79, 99, 100] and the crossover study [90].
Several studies (39%) did not report on factors influencing the pain and/or distress outcomes of clinical hypnosis [73, 74, 81–85, 87–89, 92, 94, 96, 100, 104, 106]. Reported influencing factors included intervention timing (e.g., during subsequent procedure), hypnotherapist’s presence (e.g., hetero or self-hypnosis), child baseline and procedural distress or anxiety, chemotherapy-induced emesis (i.e., vomiting process), rapport with the hypnotherapist, and parents’ distress-promoting behavior (Table 5) [45, 72, 77, 78, 91, 93, 98, 99, 105, 107]. The type of suggestions had a non-significant effect on hypnosis pain, anxiety, and behavioral distress outcomes with both direct and indirect suggestions yielding similar effects [91]. The effect of age on hypnosis pain and distress outcomes was reportedly non-significant [80, 97, 102, 105], significantly negative (significant effect for younger age) [45, 79, 86, 90, 107], and seldom significantly positive [86, 95]. Children’s female gender was weakly correlated with preprocedural anxiety and strongly correlated with the pain and distress outcomes of clinical hypnosis [93]. Endoscopy’s success rated by the degree of completion and children’s tolerability was linked to older age (13 vs 8 years), the type of procedures (esophagogastroduodenoscopy vs recto sigmoidoscopy), and parental presence (for esophagogastroduodenoscopy) [76]. Despite being linked to successful esophagogastroduodenoscopy, parental presence did not significantly influence the outcomes of clinical hypnosis in that study [76]. Children’s willingness to repeat procedures was linked to procedures’ success and tolerability [76].
A few studies involved anecdotal assumptions and clinical observations regarding potential influencing factors without assessing their relation to pain and distress outcomes of clinical hypnosis. Children’s exacerbated distress and vocalization of difficulties were observed with parents’ distress-promoting behavior (e.g., denying, minimizing, or reinforcing children’s experiences) or children’s previous difficulty with procedures [95, 108]. Authors postulated that nurses’ delivery or knowledge of clinical hypnosis may have influenced results by using reassuring words or similar communication techniques in non-hypnotic interventions [82, 86]. Increased oral narcotic requirements with clinical hypnosis despite reduced doses of intravenous narcotics and pain treatment duration were postulated to be due to earlier hospital discharge [101]. Factors proposed to affect pain outcomes entailed low hypnotic suggestibility and abnormal pain pathways inducing hyperalgesia (i.e., increased sensitivity to painful stimuli [109]) and/or allodynia (i.e., pain with non-painful stimulus [5]) causing burning sensations during procedure rehearsal [77]. Pain and distress outcomes were postulated to be influenced by reduced hypnotic engagement due to procedure-related instructions as well as exacerbated fears linked to the inexperience of the hypnosis provider, parents’ behaviors, and children’s history of frequent procedures [81]. When using hypnosis with midazolam and inhaled anesthetics, reduced post-procedural pain and improved mood were presumably linked to midazolam’s related amnesia, children’s coping strategies, positive conditioning (at the second treatment session), and parental presence whereas reduced cooperativeness was linked to anesthesia [75].
Hypnotic suggestibility, referring to the capacity to respond to hypnotic suggestions, has been postulated to be a strong predictor of clinical hypnosis outcomes [31, 32, 36, 110]. The correlation between hypnotic suggestibility level and the pain and distress outcomes of clinical hypnosis was reported to be strong in seven studies [91–93, 97–99, 103] and weak in three studies [104, 106, 108] (Table 5). The majority of studies (66%) did not assess hypnotic suggestibility nor the relationship with outcomes [72–78, 80–87, 89, 90, 94–96, 100–102, 105, 107], whereas 8% of studies assessed hypnotic suggestibility alone without assessing its relation to outcomes [45, 79, 88]. Hypnotic suggestibility was mainly assessed using the Stanford Hypnotic Clinical Scale [45, 79, 91, 92, 97–99, 103, 104, 106] with few studies using other measures, including the hypnotic induction profile [108], the eye-roll test [88], and post-hypnotic response scale [93].
The characteristics of the 2,205 child participants included in the scoping review are summarized in Table 1 and detailed in Table 6. The number of study participants ranged from less than 30 in 31% of studies to more than 90 in 13%. Participants’ age varied between 4 and 22 years although data from adult participants were not included in this review, and three studies did not report participants’ age range. Clinical hypnosis was examined in children undergoing diverse medical procedures in broad pediatric contexts, including oncology (42%), dental (18%), orthopedic (8%), surgical and miscellaneous procedures (21%, e.g., lower abdominal surgery, burns dressing changes), and medical examination (11%).
Rates of refusal to participate reported in 42% of studies were between 0% and 52% [76, 78, 81, 82, 85, 92, 96–100, 102, 105–108]. Parents refused participation for the reasons of thinking that hypnotic discussion or training would bring undo attention to medical procedures and increase children’s anxiety [107], not wanting a reminder of the illness, or claiming that children had no problem [105]. Children refused participation due to a lack of interest or religious reservation [96]; finding no need for interventions [102]; unsuccessful previous hypnosis [105].
Participants were reported to drop out in 21% of studies with attrition rates ranging from 2% to 52% [77, 81, 82, 86, 94, 103, 104, 106]. Participants’ consent withdrawal was due to rejecting hypnosis (perceived conflict with religion, feeling uncomfortable during hypnosis, insufficient motivation), perceived benefits, or parental interference (e.g., insisting on practice) [77, 82, 86, 94, 103, 104, 106]. Failure to complete studies was reportedly due to treatment changes (e.g., procedure cancellation, treatment end, reduced number of procedures) or relapses [77, 82, 86, 94, 103, 104, 106]. Unplanned children or parents’ circumstances (e.g., child urgent hospital admissions or death, changes in parental work or schedule) and parents’ difficulty in finding time for children’s hypnosis were also reported to interrupt participation [77, 82, 86, 94, 103, 104, 106]. Higher baseline anxiety was observed in children rejecting hypnosis in a study [94]. However, their small number (n = 2) [94] and the higher participation rate in children with higher anxiety expression reported in another study [92] precluded conclusions regarding the impact of anxiety on willingness to participate.
The delivery mode, time, duration, frequency, provider, components, and context of clinical hypnosis and comparators are detailed in Table 7. The context of delivering interventions was described in most studies (95%, except two [92, 101]), with most interventions delivered in a single context (76%) and at metropolitan hospitals (65%).
Clinical hypnosis interventions varied in their delivery modes (taped/pre-recorded or live), providers (hetero-hypnosis guided by a clinician or experimenter or self-directed hypnosis), timing (pre, post, or intra-procedural), and doses (duration and frequency). Most studies (84%) entailed live interventions, including hetero-hypnosis (55%) [45, 72–76, 79, 81, 82, 84–88, 90, 92, 96, 97, 102, 105, 107] or self-hypnosis with live hypnosis training or hetero-hypnosis (29%) [77, 78, 91, 93–95, 98–100, 106, 108]. A minority of studies used taped hypnosis (5%) [80, 89], both live and taped hypnosis (3%) [104], or self-hypnosis tapes as adjuncts to live hypnosis (8%) [83, 101, 103]. Clinical hypnosis was provided before (29%) [76, 78, 81, 83, 88, 90, 91, 96, 97, 104, 107], during (18.5%) [72–74, 79, 80, 82, 102], or both before and during procedures (47.5%) [45, 75, 77, 86, 87, 89, 92–95, 98–101, 103, 105, 106, 108]. Intra and pre-procedural hypnosis either started before procedures and continued during procedures or were conducted both before (hypnosis training or hetero-hypnosis) and during (self-hypnosis) procedures. The duration of procedural hypnosis varied across the 3 studies that reported on this aspect (20, 40, and 45 minutes) [93, 98, 99]. Durations of pre-procedural hypnosis ranged from a few minutes (1–5 minutes) to 80 minutes. Two studies (5%) did not report the timing or duration of clinical hypnosis [84, 85]. The duration of comparator interventions varied between procedures and was reported to be equal to clinical hypnosis or longer. Although the frequency of delivering interventions was seldom reported, the frequency of procedural interventions could be implied from the reported frequency of procedures.
Clinical hypnosis was based on tell-show-do and confusion techniques [75]; force-animal, color, bird-swing, and magic arm induction techniques [75]; Erickson’s approach [72, 76, 77]; Gardner’s self-hypnosis model [98–100, 106]; Lobe’s model [78, 83]; a psychiatry book [112]; a book on hypnotherapy in children and adolescents. However, most studies inadequately reported clinical hypnosis by providing minimal details or not reporting interventions (3%) [87], inductions (32%) [73–75, 82, 84, 86, 89, 96, 102, 103, 107, 108], the hypnotic context, therapeutic suggestions (content and phrasing style), and de-inductions. More than half of studies (58%) reported on pre-hypnosis interviews [45, 72–75, 78, 82, 87–89, 91, 94, 96–99, 103–108], and only a few studies (10%) reported on post-hypnotic interviews [74, 75, 78, 83].
Several studies (29%) used a treatment manual or an equivalent, including clinical hypnosis tapes transcripts [89]; department standard care manual [72]; attention control and clinical hypnosis manuals [98–100]; hypnotic induction and arm levitation script [79]; aged matched manual [104] or training protocols for distraction and clinical hypnosis [103]; standardized prewritten clinical hypnosis [82]; a manual for self-hypnosis training, hypnotic induction, and suggestions [106]; or scripts including mental images from which participants could choose their favorite images for clinical hypnosis [67].
A few studies (10%) used fidelity measures to assess adherence to treatment manuals as well as report modifications and deviations [98–100, 103]. In recent studies, an independent observer rated therapists’ adherence to manuals during randomly selected intervention procedures on a visual analog scale from 0 (completely different) to 10 (exactly as described) through direct observations and analysis of sessions [98–100]. In these studies, treatment fidelity as assessed by mean concordance between therapists' delivered treatments and manuals was high [98–100]. The most reported deviation from the manual was physical contact by therapists in response to children’s requests and brief discussions about children's activities and interests (e.g., school and sports) [98, 99]. Authors considered the adherence rate satisfactory and minor deviations necessary for rapport with participants and ethical care. In the earlier study, parents delivering interventions assessed compliance with the training protocol by recording hypnosis practice on a chart for seven daily intervention sessions [103]. This study reported a non-significant deviation in the amount of child intervention practice as determined by parents’ reports except for a single case that was not included in the study due to child death (cause of death unknown) [103]. Videotapes and adherence checks showed that parents used clinical hypnosis and distraction faithfully and accurately although many parents stopped using the arm-lowering item from the hypnotic suggestibility scale during interventions [103]. Despite not using a treatment manual, a study reported that not all suggestions were given to each child [91] and another study indicated that hypnotic suggestions were shortened in subsequent sessions after hypnosis became familiar [92].
Several studies (76%) reported tailoring clinical hypnosis (i.e., delivering interventions that are not identical among participants [72–75, 77, 78, 81–83, 86, 88, 90–96, 98–100, 102–108]. Clinical hypnosis was tailored to children’s preferences, including favorite places and activities [108]; favorite characters, stories, and mental images from scripts [73]; desired imagined journey [82]; and favorite therapeutic suggestions [74]. Tailoring was also based on children’s age, sensory capacities, and cognitive development [74]; response and cooperation degree (until satisfactory outcomes) [88]; developmental level, interests, and individual needs [77]; interests [93]; interests and needs [94]; or needs [75]. Tailoring also involved including personal content in hypnotic stories or adventures [90] and adapting inductions to children’s interests [72] or age, social-cognitive development, and interests [81]. The therapist’s observation of child behavior and clinical judgement of their needs was also used to guide tailoring wording and details of inductions, intensification techniques, and specific induction suggestions [45]. Furthermore, clinical hypnosis was individualized despite following a basic pattern where procedure rehearsal was prominent (hypnotic induction, visualization, hypnotic simulation of procedure) [92]. In a study, despite the absence of tailoring to each child, clinical hypnosis was adapted for children undergoing dental extractions whereas the comparator (progressive muscle relaxation) was adapted to the general pediatric population [85].
Non-hypnotic comparator interventions were also tailored in a few studies (10%), including tailoring non-medical play [98] and distraction [104] to children’s age and interests and preferences, and integrating children’s preferred cartoons/TV shows or movies and sensory type in audio-visual distraction aids [73]. Distraction and breathwork were also tailored based on knowledge of children, family, and situational factors [102]. Intravenous analgesia or local anesthetic infusion was chosen based on surgeons’ preferences and patients’ previous opioid experiences [78, 83]. Analgesics doses were adjusted to promote pain relief and safe analgesic administration [78]. Adjunct interventions were also tailored by adapting sedative doses to children’s body weight [76]; allowing children to choose the mode of administrating anesthesia (inhaled or intravenous induction) [74] or the administration of midazolam and/or inhaled anesthesia [76].
Barriers and facilitators to implementing clinical hypnosis and study procedures were seldom reported and were based on clinical observations without assessing their effect on implementation outcomes. Barriers related to children (e.g., age, desire to watch procedure, coping strategies), hypnosis providers, and hypnotic components (using procedural landmarks, establishing a hypnotic relationship) were reported to affect intervention ease, therapeutic relationships, and therapy engagement. For instance, children’s age and motivation for successful outcomes were linked to excellent cooperation, irrespective of children’s hypnotic suggestibility [88]. Potential confounding factors postulated to exacerbate children’s anxiety towards using new techniques (e.g., imagery) entailed the desire to watch the procedure or comfort in using well-established coping strategies [77]. Explaining procedural steps (e.g., needle insertion) was reported to assist in relieving child worries about unpleasant surprises for better fantasy involvement, especially that most children wanted to know about procedures [102]. Children’s fantasy involvement was also promoted by weaving humor, adventure, and magic within stories designed based on children (e.g., family and anxiety levels) [102]. Establishing a therapeutic relationship between one of the hypnotherapists and patients promoted hypnotherapists’ interchangeability (allowing the other hypnotherapist to establish rapport with children following primary contact immediately before a procedure) and facilitated clinical hypnosis [94].
Several studies reported that parents were present during procedures with involvement (18%) or without reported involvement (26%). Parents actively participated in the pre-hypnotic discussion [104]; were instructed to assist child self-hypnosis [108]; and were encouraged to cue child self-hypnosis or participate in group child and parent hypnosis unless contraindicated [106]. Parents were also requested to actively comfort children, refrain from over-reassurance, as well as briefly encourage and cue children to practice clinical hypnosis [99, 100]. Furthermore, after observing children’s clinical hypnosis training (coaching breathing, relaxation, and imagery), parents were trained to coach child hypnosis under the supervision of hypnotherapists who emphasized increased parent involvement at stress points to promote positive experiences [103, 107].
Almost half of the studies (48%) inadequately reported the experience or training of clinical hypnosis providers due to absent (30%) or insufficient information (18%). In a study, an integrative medicine physician provided the post-hypnotic discussion, but the clinical hypnosis provider was not reported [83]. Clinical hypnosis was provided by medical personnel trained in hypnosis (39%), including doctoral students [45, 103, 107]; anesthetists [72, 87, 88]; dentists [75, 79, 89, 90], and nurses specialized in oncology-hematology, pediatric endoscopy, pediatrics, or anesthesia [76, 77, 81, 82, 96]. Clinical hypnosis was seldom provided by psychologists trained in hypnosis (13%), including a psychologist experienced in the psychology of oncology and hypnosis [93], a research psychologist experienced in hypnosis for pain [97], or a medical student certified in psychiatry and trained by a psychiatrist [85]. Clinical hypnosis was also provided by specialists not reported to receive a hypnosis training, including pediatric psychologists and pediatricians [94, 102].
In 53% of studies, providers of comparator interventions were inadequately reported by absence of information on comparators [75, 76, 91, 92, 94, 95, 106] or providers [73, 74, 78, 80, 81, 83–85, 87, 89, 105], and labeling providers as therapists without adequately reporting their experience or training [100, 108]. One of these studies reported that a therapist conducted clinical hypnosis and attention control without mentioning whether this was the same provider [100]. Medical staff [45, 77, 86, 98, 99, 104, 107], a dental student [72], and anesthetists (providing anesthesia) [88, 101] provided standard care. A trained psychology-counselling student provided counselling [107], a therapist provided attention control [98], and experimenters provided distraction [86, 104]. Clinical hypnosis providers also delivered comparator interventions [79, 82, 90, 93, 102, 103]. For instance, in a study, cognitive-behavioral therapy was provided by the hypnosis provider who had received cognitive-behavioral therapy training whereas hospital staff provided standard care [97]. In another study, standard care was delivered by the hypnosis provider, nurse, and/or child life specialist [96].
This review mapped evidence on clinical hypnosis for children’s procedural pain and distress and explored areas relevant to research conduct and intervention delivery that have not been adequately reviewed, and thus has important research implications. Highly variable rates of attrition (2–52%) and unwillingness to participate (0–52%) were respectively reported in 21% and 42% of studies included in the review. Furthermore, the safety of clinical hypnosis was reported in only 3 studies in the current review and has been inadequately examined in previous reviews (e.g., [17, 18, 30–36]). Thus, the safety and acceptability of clinical hypnosis in children undergoing medical procedures warrant further examination to ensure protecting participants and promote their participation in clinical hypnosis research. Furthermore, studies in this review mainly collected quantitative data, and thus qualitative research is warranted to further examine the acceptability of clinical hypnosis for children’s procedural pain and distress by exploring children’s misconceptions and hypnotic experiences in greater depth.
This review identified individual, interventional, and social influencing factors that warrant further attention. Based on this review, the level of hypnotic suggestibility was weakly (two studies) or strongly (seven studies) correlated with superior pain and/or distress outcomes of clinical hypnosis. These results converge with previous reviews and meta-analyses reporting a weak to strong correlation between hypno-analgesia and hypnotic suggestibility in children undergoing medical procedures [28, 32, 34, 36, 113, 114]. Other factors may have influenced the variability of the correlation between hypnotic suggestibility and clinical hypnosis outcomes. For instance, according to a meta-analysis including adults and children, labelling clinical hypnosis interventions as “hypnosis”, smaller sample sizes, pre-procedural and live delivery of hypnosis were linked to less procedural pain and distress [28]. Consistently, this scoping review reported the influence of the hypnotherapist’s presence (hetero-hypnosis) and intervention timing (in subsequent procedures) on improved outcomes. However, this review did not report the effect of sample sizes nor identify the impact of labelling interventions on the outcomes of clinical hypnosis. Furthermore, similarly to the other reviews focused on children, the current review identified other factors influencing clinical hypnosis outcomes, including child baseline distress or anxiety; female child gender; chemotherapy-related emesis; and parents’ distress-promoting behavior [29]. The heterogeneity of reported influencing factors related to clinical hypnosis interventions (e.g., timing, delivery mode) and population characteristics (e.g., age, sample size) in this review and previous reviews prevent determining the effect of these factors [28, 29, 34, 52]. Thus, more research is needed to explore factors that may influence procedural pain and distress outcomes of clinical hypnosis in children. For instance, children’s age may interact with hypnotic suggestions (tailored/standardized, direct/indirect), delivery mode (self-hypnosis), and adjunct standard treatment [29]. Considering inconsistent reports on the relationship between age and clinical hypnosis outcomes in this review and previous research [29, 52], more research is required to determine at what age or ages clinical hypnosis is most effective. Self-hypnosis was linked to reduced clinical hypnosis effects on procedural pain and distress. However, considering the potential cost-effectiveness of self-hypnosis, further research could examine self-hypnosis in children of different ages and reduced baseline distress, as well as dose-related responses with increased self-hypnosis practice. Furthermore, evidence regarding the impact of children’s coping on the pain and distress outcomes of clinical hypnosis was not identified in the scoping review and warrants further research.
In line with previous reviews, this scoping review explored areas relevant to intervention delivery that require further investigation and highlighted problematic inconsistencies in reporting clinical hypnosis interventions that require careful attention in future studies [29]. Although treatment manuals are imperative in high-quality research to establish a therapy as empirically supported by enabling reliable treatment implementation, several studies in this review did not include treatment manuals, and most studies did not assess adherence to manuals. Furthermore, clinical hypnosis interventions were inadequately reported with missing information on techniques, providers, duration, timing, and tailoring. Based on the limited information found, there was a large heterogeneity in clinical hypnosis timing (pre, post, or intra-procedural), doses (frequency and duration), providers (training and experience), types (self or hetero hypnosis), and delivery modes (live or taped). Replicating and comparing clinical hypnosis interventions may be hindered by the heterogeneity and inadequate reporting of interventions as well as the lack of treatment manuals. As hypnosis is a complex intervention that can be delivered using varied techniques, delivery modes, and doses, further research with adequate intervention reporting is needed to evaluate the impact of intervention characteristics (e.g., delivery mode, dosage, and techniques) on outcomes and implementation [115]. Using treatment manuals or adequately describing interventions is imperative to avoid problems encountered in previous studies and can be done using intervention checklists, such as the Template for Intervention Description and Replication (TiDier) [40]. Assessing the fidelity of delivering interventions or adherence to treatment manuals is also imperative to understand how clinical hypnosis was delivered (e.g., dose, components). Researchers should also be aware of the heterogeneity of clinical hypnosis components when designing and conducting research by planning all aspects of interventions (dosage, provider, techniques, and delivery mode). For instance, future research tailoring the timing, duration, and mode of delivering interventions to study settings could help identify the most effective and feasible way to deliver clinical hypnosis for optimal procedural pain and distress outcomes in those settings. For adequate delivery of clinical hypnosis, it is also valuable to explore and address barriers and facilitators to intervention delivery. Based on this review, barriers and facilitators potentially affecting intervention ease, therapeutic relationships, and therapy engagement were related to children (e.g., age, desire to watch the procedure, coping strategies), as well as hypnosis providers and components (procedural landmarks, hypnotic relationship).
This scoping review also identified other methodological limitations in included studies, entailing small sample sizes (less than 30 in 31% of studies), inadequate reporting of randomization procedures, and lack of use of theoretical frameworks consistent with previous systematic reviews [28, 52]. Except for a study that used a theoretical framework (Piaget’s cognitive theory) to choose participants’ age range, studies included in this review did not use a theoretical or implementation science framework to guide exploring and implementing clinical hypnosis and study procedures. Moreover, several included studies did not adequately report standard care used as an adjunct to clinical hypnosis. Considering the variability of standard care with different procedures and settings (e.g., general anesthesia, local anesthetics), providing more information on standard care is required in research examining the use of clinical hypnosis in combination and/or comparison to standard care.
This review indicates the potential benefits of clinical hypnosis for children’s procedural pain and distress consistent with previous meta-analyses and systematic reviews (e.g., [28, 32, 52]). Based on RCTs in this review, outcomes related to procedural pain and distress were superior with clinical hypnosis in comparison to standard care and other interventions (e.g., distraction). However, the superiority of hypnosis outcomes was sometimes reported as insignificant, particularly when clinical hypnosis was used as a sole treatment. Furthermore, the review predominantly investigated the sensory components of pain, resulting in limited evidence regarding other components of pain, such as pain unpleasantness. Furthermore, evidence is inconsistent regarding clinical hypnosis for children’s procedural distress due to the heterogeneity of reported physiological, psychological, and behavioral distress outcomes in included studies. There is also a great deal of heterogeneity in the types of painful procedures examined in this review, with most of these procedures involving pediatric oncology consistent with previous meta-analyses [52]. Thus, further research is required to examine the effectiveness of clinical hypnosis for procedural pain and distress, including pain unpleasantness and the multiple dimensions of distress in broad pediatric contexts beyond oncology. New research could also focus on pain and distress related to imaging procedures (MRI, CT scan) and relatively new procedures (e.g., brachytherapy, radiosurgery) that were not examined as part of the scoping review and were inadequately reported in previous reviews [38]. Also, positive outcomes, such as relaxation, satisfaction, and perceived self-efficacy, were seldom reported in this scoping review and were inadequately reported in previous reviews (e.g., [28, 34, 52]) and thus warrant greater attention.
Studies in the review did not include comparisons nor combinations of clinical hypnosis with other distraction techniques, such as virtual reality, that are supported by evidence of utility for children’s procedural pain and distress [17, 33]. None of the included studies investigated virtual reality hypnosis, a novel technology embedding clinical hypnosis in an audio-visual sensory experience that shifts the attention from pain and distress without requiring a hypnotherapist or imagination at cues [116]. Recent studies exploring virtual reality hypnosis in adults and children undergoing medical procedures have demonstrated a reduction in pain intensity and unpleasantness with virtual reality hypnosis in comparison to control groups [116–118]. Consequently, more studies are required to compare clinical hypnosis to other distraction techniques and explore the benefits of combining clinical hypnosis with distraction techniques. However, little is known about the costs of novel technologies that may pose a barrier to implementation within budged-constrained healthcare systems [119]. Thus, analyzing the cost-effectiveness of clinical hypnosis and virtual reality hypnosis is imperative to justify the use of these interventions and promote their implementation.
The review included broad and comprehensive searches with a robust screening of several non-English studies and data extraction by two reviewers in consultation with expert hypnosis researchers. However, despite exploring areas that have been inadequately reported, the review omitted interventions with hypnotic elements (e.g., suggestions and hypnotic communication) and experimental pain conditions (e.g., [58, 120, 121]) that could be examined in future research. Although a protocol detailing the scoping review conduct was published for transparent data reporting and to avoid publication bias [56], there were minor deviations from the protocol. The population age range was proposed in the protocol as between 4 and 16 years to inform a feasibility study with children in this age range. However, due to the demographics of participants in the included studies, the age range was extended in the scoping review to all children below 18 consistently with the United Nations Convention of Child Rights [57, 58]. In the scoping review protocol, research questions concerning factors influencing clinical hypnosis outcomes revolved around factors of hypnotic responding. However, following data collection, the research questions in this review were extended to include factors influencing pain, distress, and hypnotic responding based on the extracted data. Following scoping review guidelines, minor deviations from protocols are deemed acceptable if they are based on collected data and conducted for research purposes [55]. Thus, the minor deviations in this review are considered unlikely to undermine the quality of the review or research transparency.
This review has important implications for future research and can help guide researchers and clinicians in delivering clinical hypnosis by identifying research gaps and areas relevant to research conduct and intervention delivery. Based on the review findings, further research investigating barriers and facilitators to implementing interventions and study procedures, as well as the feasibility and acceptability of clinical hypnosis in children undergoing painful procedures is warranted before examining effectiveness. Future acceptability research and surveys of attitudes toward hypnosis may enhance participation in clinical hypnosis research by exploring major misconceptions and negative attitudes that can be addressed following discussion with clinical opinion leaders. Qualitative research on clinical hypnosis in children undergoing medical procedures is also warranted to help further understand the acceptability of hypnosis by examining children’s hypnotic experiences. The review also highlights the importance of adequately reporting interventions and measuring the fidelity of delivery to replicate and compare interventions. No conclusions can be drawn regarding effectiveness without assessing the risk of bias and the certainty of the findings across outcomes, including the inconsistency of findings related to sample sizes, populations, contexts, and interventions. Systematically examining the effectiveness of clinical hypnosis, including assessing the certainty of the evidence, was beyond the scope of the scoping review. However, this review indicated potential benefits of clinical hypnosis for procedural pain and distress by highlighting the growing research, including RCTs, that suggests effectiveness despite focusing on oncology procedures and sensory pain components and providing inconsistent evidence regarding distress. Thus, the review provides a precursor to further research examining the effectiveness of clinical hypnosis for the multiple components of pain and distress in broad pediatric contexts. Furthermore, evidence has been narratively summarized, which can be used to plan the development and evaluation of tailored clinical hypnosis interventions to optimize treating children’s procedural pain and distress.
The scoping review does not necessitate ethical approval as it uses information from publicly available sources.
All authors contributed to the study design. D.G. drafted the manuscript. The screening was independently conducted by D.G. and B.A. Data extraction and synthesis were conducted by D.G. and reviewed by B.G., Z.T., B.A., D.T., and V.P. Critical review, editing, and approval of the final manuscript draft were conducted by all authors.
We would like to thank Lars Eriksson for his assistance with the database searches.
Supplementary Data may be found online at Pain Medicine online.
Dali Geagea, Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia.
Zephanie Tyack, Child Health Research Centre, Centre for Children's Burns and Trauma Research, The University of Queensland, Brisbane, Australia; Australian Centre for Health Service Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
Roy Kimble, Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, The University of Queensland, Brisbane, Australia.
Vince Polito, School of Psychological Sciences, Macquarie University, Sydney, Australia.
Bassel Ayoub, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
Devin B Terhune, Department of Psychology, Goldsmiths University of London, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK.
Bronwyn Griffin, School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
Funding The proposed research received no specific grant from any funding agency in public, commercial, or not-for-profit sectors.
Conflicts of The authors have declared no conflicts of interests.