More and more, hypnotic analgesia is being used in the emergency department (ED) to reduce pain and help patients relax while they’re being treated. In his presentation to emergency medicine professionals at the Urgences 2022 Congress, Olivier Picot, a nurse at Cochin Hospital, which is part of the Paris Public Hospital System, spoke about the hypnosis technique he uses in the ED to relieve patients’ pain. It’s an approach that has completely changed the way he views his role in providing medical care and the way he and his patients interact.
Hypnosis is an altered state of consciousness that is a kind of waking dream in which an individual can cut himself or herself off from what’s going on. To induce this hypnotic trance, the therapist speaks to the patient using suggestions or metaphors. In hypnotic analgesia, the therapist uses this method to guide patients to focus on something other than the pain and to exercise better control over what they’re feeling — physically and emotionally — while medical procedures are being performed on them.
Since a 2015 report by the French National Institute of Health and Medical Research (Inserm) acknowledged the science behind hypnotic analgesia, the approach has been gaining interest within the medical field. Inserm’s analysis of around 50 studies found that hypnosis reduces the need for painkillers or sedatives and, on top of that, is risk free.
Like hypnosedation, hypnosis is used as a complement to anesthesia or as a sedative administered during a medical intervention, such as in dental care or during fibroscopy. Hypnotic analgesia may be incorporated into the care provided by healthcare professionals in a hospital setting. One must be specifically trained in the technique for use in pain management in the ED.
Picot completed a 7-day hypnotic analgesia course offered at the French Institute of Hypnosis “as part of the hospital group’s training initiative for paramedical staff.” For 5 years, he has been putting the knowledge and skills he gained into practice.
“Hypnosis completely changed the way I carry out my role and the way I communicate with patients,” said Picot during his presentation. “The feedback has been very positive. Until I started using hypnosis, I’d never received so much thanks from my patients. Time and time again, I hear the same thing: they had no idea that there was a method for getting control of their pain, overcoming it.”
Hypnotic analgesia can be incorporated into the treatment plan to complement the medication used to manage pain. Using suggestions, the therapist guides the patient to focus on things other than the pain. The patient may be invited to imagine that they’re being carried away toward a pleasant and relaxing place; this helps the patient leave behind the surrounding reality and see what lies beyond.
To be able to act on the imagination, the therapist must first get the patient to lose touch with reality. Picot explained that the conditions in the ED are ideal for establishing that dissociative state. “When they come into the ED, patients are stressed out and anxious and feeling like they’re no longer in control of what’s going on around them. They’re already more or less dissociated.”
In this setting, hypnosis is brought about simply and quickly. “In 5 or 6 minutes, I can put a patient into a hypnotic state,” said Picot. All patients are receptive to hypnosis, “even want to be put under,” he pointed out. The most receptive are those who arrive at the ED in a heightened state of stress and in excruciating pain.
“We figure that 20% of ED patients present with the kinds of conditions that make them very receptive to hypnosis,” said Picot. These are individuals who are expressing their pain in a way that may be more than the situation warrants or who are behaving without exercising any self-control. “It’s amazing that hypnosis will quickly calm these patients down.”
The first step of hypnotic analgesia is induction. “I ask the patient to focus on a spot, on my voice, or on their breathing,” said Picot. He uses the same tone of voice as theirs. “If the patient is screaming, writhing, and complaining of pain, I’m going to come to them with the same level of intensity. This can sometimes create a situation that one’s colleagues find disconcerting.” It’s then up to the hypnotist to gradually lower the intensity of the exchange.
“Once I’ve gotten the patient to focus their attention, I ask them to think about a happy place, about their family, about an enjoyable experience,” Picot explained. “Before this, I may get them to describe their pain, asking them to associate it with, for example, a color or a shape. The hypnosis can be enhanced by using these elements, by accentuating these positive thoughts and concepts.”
The hypnotist accompanies the patient on this inward journey, inviting them to describe what they see, giving suggestions, “never as an order or a command.” All the senses are summoned to adapt to the patient and give the session direction. “When they picture themselves on a beach, some patients are more readily going to describe what it looks like, others will prefer to imagine the feel of the sun on their skin or even the sound of the waves.”
In this way, the hypnotist helps the patient establish pleasant thoughts, focus on memories, and escape from the present moment. The patient is then less receptive to the environment and to unpleasant sensations. Reducing stress and anxiety eases the perception of pain.
Tools help guide the session and adapt it to the patient. For example, the “magic glove” technique can be used to relieve pain. “While in a hypnotic state, the patient is asked to picture the perfect glove for their hand or for the hypnotist’s hand, to describe its texture, what it looks like,” said Picot. “This imaginary glove is then applied to the area of pain to provide relief.”
For a while, Picot was assisted by another healthcare professional during the sessions. These days, he performs hypnotic analgesia while he is carrying out treatment and administering painkillers. Hypnosis often takes effect in no time at all, so much so that the greatest skeptics have come to acknowledge its benefits. “Before the infusion is even set up, the patient has already been calmed down, and without being given a painkiller.”
After the medical treatment has been carried out and the patient has relaxed, the hypnotist brings the session to a close by guiding the patient back to the normal state of consciousness. “We want this to be gradual. So, counting down from five to zero or just leaving it up to the patient, telling them that they can peacefully return on their own whenever they want,” said Picot.
If the patient had a difficult time during the medical treatment and they seem exhausted, “you can even just let them fall asleep.”
Several training courses teach hypnosis. In the 7-day course that Picot completed at the French Institute of Hypnosis, students learn the basics of hypnotic analgesia. “That’s the minimum amount of time needed for this training. It’s long enough to learn the various techniques and then put them into practice.”
There are longer courses as well. In addition, there are university diploma programs that provide training in hypnosis with “a more theoretical” approach. These courses focus more on the practice of hypnotherapy, which is used for more long-term treatments than those delivered in the ED.
Picot said that one’s skills in hypnosis improve with experience, as well as by speaking with fellow practitioners. Everyone learns from each other’s experiences, and there’s no need to have continuing education. “Anyone can do hypnotic analgesia.” You just have to go for it, “without any fear of ridicule,” he said.