240 A Randomized Controlled Trial of Hypnosis for Pain and Itch Following Burn Injury

Abstract Introduction Burn survivors report that pruritus (also categorized as neuropathic pain) is common for years after injury and can affect all aspects of quality of life. Pharmacological interventions have not consistently shown to be effective and often have side effects. Hypnosis has been successfully used to treat burn pain and nonburn-related pruritus. We hypothesized that hypnosis would provide greater postburn itch and pain relief than the control at 48 hours, 1, 3, 6, 12-months post-intervention. Methods Following IRB approval, adult burn patients who had been undergoing pharmacologic therapy (gabapentin, diphendhydramine and/or cetirizine) and who scored ≥ 4 on a 0–10 Numerical Rating Scale (NRS) for itch or pain were eligible for the study. Subjects were randomly assigned to receive 4 sessions of hypnosis or treatment as usual. Both groups continued to receive pharmacologic and topical therapy. Outcome measures included NRS for pain and itch, and the 5-D Itch Scale. We conducted an intent to treat analysis of change over time for the two treatment groups on all measures. Results A total of 27 patients participated in the study, 62% were Caucasian and 60% were male. There were no significant differences between the groups on any outcome measure and both groups demonstrated improved pain and itch over time. There was a large effect size for Itch as measured by the NRS (intensity) and the 5D Itch Scale from baseline to 1 month. Of note, those in the hypnosis group had a larger burn size (24.1% TBSA burn vs 14.7%); however, this was not statistically significant. Our sample size was smaller than our target enrollment due to difficulties in subject recruitment. A total of 106 eligible participants were approached for the study but only 29 consented (two were lost to follow up). Top reasons for refusal included “did not believe in hypnosis” (25%), lost to follow up after screening but prior to consent (24%), and geographic distance prohibiting return to burn center (10%). Conclusions Itch and pain seem to improve over time. Barriers to making hypnosis a feasible nonpharmacological option for patients who report burn pain and itch as impacting quality of life should be addressed. Applicability of Research to Practice Our study demonstrates a need to educate the public about the potential benefits of hypnosis as a safe and efficacious nonpharmacological medical intervention. Further, future studies should validate the efficacy of hypnosis delivered