Liossi, C., White, P., & Hatira, P. (2009). A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain, 142(3), 255–263.

To compare the efficacy of EMLA cream to EMLA plus hypnosis in the relief of venipuncture-induced pain and anxiety; to determine whether the intervention has a beneficial effect on parents’ anxiety levels during their child’s venipuncture

Patients arriving at the unit had 2.5 g EMLA cream 5% applied over a prominent vein. Those who agreed to the study were randomized to one of three groups: EMLA alone, EMLA plus hypnosis, or EMLA plus attention. Hypnosis included a 15-minute session with a therapist in a private room. The therapist provided analgesic suggestions and led the patient in relaxation. The attention group received a 15-minute session with the therapist and engaged in conversation unrelated to the procedure. Investigators collected measures of pain and anxiety immediately after the intervention and during two follow-up venipunctures. EMLA was removed after 60 minutes.

• The sample was composed of 45 participants.
• Mean patient age was 8.4 years (SD = 2.21 years). The age range was 6–14 years.
• The sample consisted of 25 females and 20 males.
• All patients were pediatric patients with cancer.

• Single site
• Outpatient
• Children’s hospital in Greece

Randomized blinded, controlled trial

• Visual analog scale (VAS), 0–100 mm, to measure pain intensity
• VAS, 0–100 mm, to measure the intensity of anxiety of children and parents
• Procedure behavioral checklist, to document presence and intensity of 10 behaviors indicative of pain and anxiety (inter-rater reliability = 0.85), conducted on 22 procedures

• The EMLA plus hypnosis group experienced less anticipatory anxiety, procedure-related pain, anxiety, behavioral distress, and parental anxiety than did the other two groups (p < 0.001).
• The benefits that the EMLA plus hypnosis group enjoyed continued through the two consecutive venipunctures: significant change in mean self-reported pain over time (p < 0.001) and anxiety over time (p = 0.007).

The study showed that hypnosis, used in conjunction with the local anesthetic EMLA, helped to decrease procedure-related pain anxiety, and distress in pediatric cancer patients. In addition, the intervention helped to decrease parental anxiety.

• The study had a small sample, with fewer than 100 patients.
• The study had a risk of bias due to lack of blinding.
• The intervention must be implemented by a trained therapist. This fact could decrease the feasibility of the intervention.

Oncology nurses in the pediatric setting may want to advocate for the use of hypnosis, along with local anesthetic, to decrease the pain and anxiety of venipuncture.