Hypnosis after an adverse response to opioids in an ICU burn patient

Burn injuries produce severe wound care pain that is ideally controlled on intensive burn care units with high-dosage intravenous opioid medications. We report a case illustrating the use of hypnosis for pain management when one opioid medication was ineffective.

Intensive burn care unit at a regional trauma center.

A 55-year-old man with an extensive burn suffered from significant respiratory depression from a low dosage of opioid during wound care and also experienced uncontrolled pain.

Rapid induction hypnotic analgesia.

Verbal numeric pain scale, and pain and anxiolytic medication usage.

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

This case illustrates that hypnosis can not only be used easily and quite appropriately in a busy medical intensive care unit environment, but that sometimes this treatment may be a very useful alternative when opioid pain medication proves to be dangerous and ineffective. This case also illustrates possible clinical implications both 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 can be activated in a highly effective manner, that clinical context may be important for the activation of those pathways, and that those mechanisms may be accessed more easily than opioid mechanisms.