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

Objective: Bum 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. Setting: Intensive bum care unit at a regional trauma center. Patient: A 55-year-old man with an extensive bum suffered from significant respiratory depression from a low dosage of opioid during wound care and also experienced uncontrolled pain. Intervention: Rapid induction hypnotic analgesia. Outcome Measures: Verbal numeric pain scale, and pain and anxiolytic medication usage. Results: 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. Conclusions: 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 contenxt may be important for the activation of those pathways, and that those mechanisms may be accessed more easily than opioid mechanisms.