A serious burn hurts twice. First there is the injury. Then, for days or weeks, there is the treatment: dressings removed, wounds cleaned, dead tissue taken away, sometimes every day. Even strong opioid painkillers often fail to control the pain of these procedures, and patients come to dread them.
It is one of the hardest tests any pain treatment can face, and one where hypnosis has been studied for decades.
Why burn care suits hypnosis
- The pain is predictable. Procedures happen at set times, so preparation is possible.
- Anticipation makes it worse. Dread builds before each dressing change, and anxiety amplifies pain.
- Medication has limits. High doses bring side effects, and still may not be enough.
- Patients are motivated. People in severe pain are often very willing to try.
Researchers have also noted that burn patients can be unusually responsive to hypnosis, perhaps because of that motivation and the dissociation that often follows trauma.
What the research shows
Much of the work was done by psychologist David Patterson and colleagues at a regional burn centre in Seattle.
A controlled trial. In one of their studies, burn patients were randomly assigned either to hypnosis before wound care or to an attention control, in which a psychologist visited to talk about their burns and what to expect. Those who received hypnosis had significantly greater reductions in pain.
A meta-analysis. A systematic review pooled randomised trials that compared hypnosis with other interventions during dressing changes in adults with burns. Only six studies met the criteria. Across them, hypnosis significantly reduced pain intensity and anxiety. There was no difference in the amount of medication used.
So the evidence supports hypnosis for pain and anxiety during burn care, from a small number of trials.
How it is done
The method most used in burn units is short and practical, since patients are unwell and time is limited.
- Before the procedure, a clinician guides a brief induction, often by counting and progressive relaxation.
- Suggestions are given for comfort, calm, and time passing quickly.
- A post-hypnotic cue is set. For example: “When the nurse touches your shoulder, you will return to this comfortable state.”
- During wound care, the nurse gives the cue. The psychologist does not need to be there.
- Afterwards, the patient is taught to use it again.
Common suggestions include imagining the area as cool and numb, being somewhere else entirely, or drifting above the bed.
Virtual reality
The same team pioneered immersive virtual reality for burn pain, including a snowy world designed to feel cold. They later combined it with hypnosis, delivering the induction through a headset for patients too unwell to imagine a scene. Early results are promising, though it has not been shown to beat ordinary hypnosis.
Children
Burns are common in young children, and dressing changes are distressing for the child, the family and the staff. Hypnosis and imagery suit children well. Trials have been set up to test whether medical hypnosis reduces pain in children with acute burns, and whether it speeds healing, which remains an open question.
Beyond the pain
Burn recovery is long. Hypnosis is also used for:
- Itching as wounds heal, which can be severe
- Sleep problems and nightmares
- Anxiety about procedures and physiotherapy
- Coping with changes in appearance
Post-traumatic stress after a burn needs proper psychological treatment.
What it is not
- Not a replacement for pain relief. It is added to medication, never used instead.
- Not first aid. A burn needs cooling and medical attention, not hypnosis.
- Not available everywhere. It depends on trained staff, and many units do not offer it.
- Not guaranteed. Some patients respond strongly and some very little.
Burn first aid, briefly
Cool the burn under cool running water for 20 minutes as soon as possible. Remove clothing and jewellery near it unless stuck. Cover loosely with cling film or a clean, non-fluffy dressing. Do not use ice, creams or butter. Get medical help for anything larger than the person’s hand, any deep or white burn, burns to the face, hands, feet or genitals, chemical or electrical burns, and any burn in a child.
If you or a relative is in a burn unit
- Ask whether psychological support, relaxation or hypnosis is available.
- Ask staff to explain each procedure beforehand.
- Practise slow breathing and a calm-place image before dressing changes.
- Agree a signal for a pause.
The bottom line
Burn care asks more of pain relief than almost anything else in medicine. Used alongside medication, hypnosis reduces pain and anxiety for many patients, and it deserves to be more widely offered.
Next in the series: Can Hypnosis Speed Up Healing? What Two Small Studies Found
This article is for general information and is not medical advice.