Positive Health Online

Abstract

OHRBACH and colleagues, Department of Psychiatry, University of Washington School of Medicine, Seattle 98104-2499 USA write that burn injuries cause severe wound care pain which is ideally controlled in intensive burn care units using high-dose intravenous opioid medication. The authors report a case illustrating the use of hypnosis for management of pain when the opioid medication was ineffective.

Background

Methodology

The patient, a 55 year old man in an intensive burn care unit at a regional trauma centre, with an extensive burn was suffering from significant respiratory depression from a low dosage of opioid during wound care and was suffering uncontrolled pain. The treatment intervention was rapid induction hypnotic analgesia. The outcome measures were verbal numeric pain scale, and pain and anxiolytic medication usage.

Results

The introduction of hypnosis, supplemented by little or no opioids, resulted in excellent pain control the absence of need for supplemental anxiolytic medication, shortened length of wound care, and a positive staff response over a 14-day period.

Conclusion

This example demonstrates that hypnosis can be used easily and quite appropriately within the environment of a busy medical intensive care unit, and that this treatment may be a highly useful alternative when opioid pain medication proves to be dangerous and ineffective. This case also illustrates the possible clinical implications both for pain relief and side-effect profiles for opioid receptor specificity. Although this report does not provide data regarding hypnotic mechanisms, it is clear that with some patients nonopioid inhibitory mechanisms may be activated in a highly effective manner, that clinical context may be important for the activation of those pathways and that these mechanisms may be accessed more easily than opioid mechanisms.

References

Ohrbach R et al. Hypnosis after an adverse response to opioids in an ICU burn patient. Clin J Pain 14(2): 167-75 Jun 1998.

Comment

What a valuable published report this is, demonstrating how a technique such as hypnosis can be applied within an intensive care setting to reduce pain which is not responding to narcotics. I hope that if I were a burn patient, someone in the emergency unit could apply hypnosis to help relieve my suffering.