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Autonomic Cardiac Reactivity to Painful Procedures Under Hypnosis in Pediatric Emergencies: A Feasibility Study
Julie Excoffier1, Vincent Pichot1, Aymeric Cantais1
1CHU de Saint-Etienne, Saint-Etienne, France.
Insights
Clinical hypnosis effectively manages pain in children by reducing sympathetic cardiac pain reactivity during medical procedures. Parasympathetic activity may indicate the depth of hypnosis, while reduced sympathetic response suggests pain relief.
Area of Science:
- Pediatric Emergency Medicine
- Autonomic Nervous System Physiology
- Clinical Hypnosis Research
Background:
- Pain sensation involves significant autonomic nervous system (ANS) reactivity.
- Clinical hypnosis is recognized for its efficacy in pediatric pain management.
- The specific impact of hypnosis on autonomic pain responses in children during clinical procedures remains unclear.
Purpose of the Study:
- To investigate the modulation of autonomic responses during suturing in pediatric emergencies using clinical hypnosis.
- To assess whether hypnosis influences sympathetic and parasympathetic reactivity in children experiencing procedural pain.
Main Methods:
- A study involving 42 children (mean age 6.5 years) divided into hypnosis and control groups.
- Time-frequency analysis of RR intervals (heart rate variability) to assess parasympathetic (high frequency power [HF]) and sympathetic (low frequency power [LF], LF/HF ratio) reactivity.
- Utilized the Analgesia Nociception Index (ANI®) as a measure of pain perception.
Main Results:
- Heart rate interbeat intervals (RRI) and the LF/HF ratio differed significantly between groups during suturing (p < 0.05).
- The hypnosis group exhibited higher RRI and lower LF/HF ratio compared to the control group.
- HF and ANI® increased specifically during hypnosis, suggesting enhanced parasympathetic activity and potential pain relief.
Conclusions:
- Hypnosis in pediatric emergencies effectively reduces sympathetic cardiac pain reactivity.
- Increased parasympathetic activity (HF) and ANI® may serve as indicators of hypnosis and pain relief, respectively.
- Hypnosis offers a viable non-pharmacological approach to managing procedural pain in children.
Abstract:
Pain sensation is characterized by abrupt changes in central nervous system activity producing autonomic reactivity. While clinical hypnosis has demonstrated its benefits for children in pain management, it is not clear whether hypnosis modulated autonomic pain response in children in clinical conditions. Here, we studied autonomic responses under hypnosis to sutures in pediatric emergencies. For that, 42 children (mean age: 6.5 years, range 1.5 to 13) were divided into two groups consecutively (hypnosis and control groups), according to their choice. Time-frequency analysis was applied on RR intervals (heart rate interbeat intervals, or RRI) to estimate parasympathetic reactivity based on high frequency power (HF) and the Analgesia Nociception Index (ANI®) and on sympathetic reactivity (low frequency power [LF]) and LF/HF ratio). We observed that RRI and LF/HF ratio varied according to suture and hypnosis (p < 0.05): RRI was higher and LF/HF ratio was lower during sutures in the hypnosis group in comparison to the control group whereas HF and ANI® increased only during hypnosis. To conclude, hypnosis in pediatric emergencies reduces sympathetic cardiac pain reactivity and could be a marker of pain relief under hypnosis, while parasympathetic activity seems to be a better marker of hypnosis.
