Clinical Reviews
An Hypnotic Suggestion: Review of Hypnosis for Clinical Emergency Care

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Abstract

Background

Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings.

Objective

This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas.

Discussion

A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems.

Conclusions

Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings.

Introduction

Although hypnosis has been used in medicine for nearly 250 years, emergency clinicians rarely use it in emergency departments (EDs) or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses some reasons why the technique has not been widely adopted and suggests some methods to increase the use of hypnosis in emergency care, including potential areas for emergency medicine−related research.

Section snippets

What Is Hypnosis?

Although its etymology derives from the Greek hypnos, meaning sleep, hypnosis is actually a state of highly focused awareness. Hypnosis, familiar to most people as a staple of stage shows, film noir, and psychiatric practice, often appears under other guises, such as meditation, religious ecstasy, guided imagery, therapeutic imagery, suggestive therapeutics, guided meditation, and biofeedback. Hypnotic trance states can also occur naturally, as when reading an absorbing book, watching an

Brief History of Hypnosis

Medical and religious practitioners have used hypnosis for millennia under various names. Calling it “sacred sleep,” Egyptian priests used hypnosis for religious and medical purposes at least 4000 years ago; the ancient Greeks were treated with hypnosis in “sleep temples of the sick.”

Medical hypnotism's modern era began in 1778, when the Austrian physician Franz Anton Mesmer introduced it in France under the unfortunate name “animal magnetism.” In the 19th century, surgeons John Elliotson and

Is Hypnosis Real?

Neurophysiologic studies demonstrate that hypnosis differs from simple imagination, placebos, and sleep (21). Research using positron emission tomography (PET) shows that hypnosis involves the anterior cingulate cortex and that actual changes occur in the brain's perception that do not occur when a suggestible person simply follows instructions 22, 23. PET also shows that hypnosis, through the midcingulate cortex modulating a large cortical network, actively decreases a person's subjective and

Uses in EM and Emergency Medical Systems

Hypnosis has been sporadically discussed in the emergency medical literature, and is even rarer in the emergency medical systems (EMS)/wilderness medicine literature 15, 37, 38, 39, 40, 41, 42, 43, 44. Hypnosis fulfills nearly all requisites of the ideal EM intervention; it is safe, fast, readily available, cost effective, uses minimal personnel and equipment, and has no risks. In addition, it can be used in any age group, including the elderly, with children aged 7 to 14 years old being

Hypnotic Techniques

Multiple techniques to induce hypnosis have been described, including the arm-drop, arm levitation, association, bionic arm (for children), confusion, two-finger, and direct gaze (60).

Basic hypnotic techniques are easy to learn. Most clinicians have or can learn the interpersonal communication skills and the methods to put people at ease that foster successful hypnosis; many physicians with a “good bedside manner” already use some of these elements, such as calm reassurance, a steady speech

Hypnotizability

The common myth is that only gullible people or those with deficient intellects can be hypnotized. In reality, only those with the power to concentrate can be hypnotized. Hypnotic suggestibility is a sign of psychological health. Those with very low intelligence, schizophrenics, patients inebriated with drugs and alcohol, and those with organic brain syndrome cannot usually be hypnotized, although that varies with the individual subject (47). Boulton and Cole, writing about anesthesia in

Why Don't Emergency Clinicians Use Hypnosis?

Discussing hypnosis in 1989, Bierman wrote, “Direct clinical application of such phenomena to medical emergencies has received only sporadic attention” (39). Although medical hypnosis has been used for millennia, most emergency clinicians hesitate to use this nonpharmacological intervention for a variety of reasons, including its association with alternative-complementary medicine. As Boulton wrote, “It is a pity that hypnosis, admittedly through the fault of some of its practitioners, often

Potential Hypnosis Studies in EM

Investigational studies will be needed to identify how hypnosis can best be used in EM. Hypnosis offers ED and prehospital practitioners numerous investigational opportunities. Study areas can be most easily divided into patients, methods, and outcomes.

Patient-related studies might usefully address what factors make EM patients more hypnotizable, such as age, presenting complaint, chronic or acutely administered medications, level of alcohol/illicit drug use, prior hypnotic experiences, and

Conclusions

Hypnosis holds enormous potential as a safe nonpharmacologic tool for patient care in emergency medicine, prehospital care, and remote medical settings. Advancing its use in EM and prehospital care will require research into the most effective techniques, delineating in which acute care situations, where it is most effective, providing education and training in hypnotic techniques, and, eventually, its endorsement by major professional organizations and inclusion in required curriculums.

Every

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