Richardson, J., Smith, J.E., McCall, G., & Pilkington, K. (2006). Hypnosis for procedure-related pain and distress in pediatric cancer patients: A systematic review of effectiveness and methodology related to hypnosis interventions. Journal of Pain and Symptom Management, 31(1), 7084.

To evaluate the evidence, from controlled clinical trials, relating to the effectiveness of hypnosis for reducing procedure-related pain and distress in pediatric cancer patients

• Databases searched were MEDLINE, EMBASE, Allied and Complementary Medicine Database (AMED), Centralised Information Service for Complementary Medicine (CISCOM), CINAHL, PsycINFO, and the Cochrane Library.
• Searched keywords were neoplasm, tumor, melanoma, cancer, chemotherapy, palliative care, terminal care, and hypnosis.
• Studies were included in investigators' analysis if
  • They were relevant systematic reviews or controlled clinical trials that included outcome measures for pain.
  • They included pediatric patients, with a primary diagnosis of cancer, who were undergoing painful and invasive treatment-related procedures (lumbar puncture, venipuncture, bone marrow aspiration).
  • In the study, hypnosis was used as a specific intervention.
  • Patient- or observer-reported clinical measures of physical pain or anxiety or distress were recorded,
• Studies were excluded if treatment included chemotherapy or if the studies did not include a control group.

• Investigators retrieved nine studies. The studies comprised one systematic review, seven randomized controlled trials, and one nonrandomized controlled trial.
• Authors analyzed eight studies, reviewing design, sample, inclusion criteria, complementary and alternative medicine treatment, control, outcome measure(s), results, methodology, comments, and clinical comments.

• The sample was composed of 313 patients.
• All patients had a diagnosis of cancer and were undergoing a painful procedure. Cancer diagnoses included lymphoblastic leukemia, acute myeloblastic leukemia, and nonmalignant blood disorder.
• None of the studies identified cancer stage. Some studies did not report the percentages of male participants and female participants.
• Authors did not identify the age range of patients.

Using rating scales in the pediatric population is a useful and valid procedure. Some studies included observations of procedure-related behavior, and these observations showed that the intervention yielded some benefit, although the observer's criteria are unspecified. Some studies showed that the level of hypnotizability, as  measured by the Stanford Hypnotic Clinical Scale for Children, was related to analgesic effect, but this finding was invalid. Studies that noted and stratified for the sex of the pediatric patient reported that the child's sex was related to level of distress. Self-hypnosis was not evaluated but has been shown to have an effect on management of symptoms.

Studies reported that using hypnosis as specified had positive effects, resulting in statistically significant reductions in pain and anxiety or distress.

• Most studies had a small sample size.
• Few studies reported the method of randomization.
• The studies did not provide enough information about the duration of the hypnosis session, whether parents were present, and who provided the information about intervention results.

Work remains to be done in this area. Researchers should focus on age, developmental stage, and the association between the sex of the child and the effectiveness of the intervention.