Implementation of Hypnotherapy in Burn Pain Patients with Pain: A Case Report
Introduction: Burn-related pain significantly impacts patients both physiologically and psychologically. Pain and associated psychosocial issues, such as anxiety and fear, can intensify the patient’s suffering. Effective pain management for burn patients includes both pharmacological and non-pharmacological interventions. Methods: A patient diagnosed with severe burns (24% total body surface area, deep dermal/full-thickness) was treated in the intensive care unit of Dr. Soetomo Hospital, undergoing debridement on the chest and left arm. The patient reported severe pain (VAS 7) and anxiety (HAM-A 26). Anxiety, particularly related to anticipation of treatment, appeared to exacerbate pain perception. The therapist assessed the patient’s understanding, beliefs, and expectations about their condition. Hypnotherapy was administered over five days, including pre-induction (assessing expectations), induction, relaxation, deepening, analgesic suggestion, and termination phases. Results: Following five sessions of hypnotherapy, the patient’s pain score decreased from VAS 7 to 2, and anxiety level reduced from HAM-A 26 (severe) to 16 (mild). The patient also received intravenous metamizole (3×150 mg), ceftazidime (2×300 mg), oral fluoxetine (1×20 mg), and clobazam (1×5 mg) during hospitalization. Conclusion: Hypnotherapy proved to be an effective non-pharmacological intervention in reducing pain and anxiety in a burn patient. It can be integrated alongside conventional treatment in various clinical settings, offering a complementary approach for managing anxiety-related burn pain.
Introductions
Burns are painful injuries and are often associated with a long and difficult recovery. Constant burn pain affects the physiological and psychological aspects of the patient. Pain caused by burns and some psychosocial problems can cause anxiety in patients. This anxiety can also increase the pain of burns. In reducing the intensity of burn pain, many pharmacological therapies are carried out, but due to concerns about the side effects of pharmacological treatment used, non-pharmacological therapy is needed to reduce the use of pharmacological treatment. Non-pharmacological therapy is currently in great demand and is developing in various aspects, including reducing acute or chronic pain in burn patients. This paper aims to analyze the effect of hypnotherapy on the intensity of acute pain in patients with burns.
Case Illustration
The examination begins with a 35-year-old male patient, a mechanical technician, lying in bed. The left chest is visible, the left arm is covered with an elastic bandage from the shoulder to the patient's palm, and the five fingertips of the patient's right hand are covered with gauze bandages. The patient visited the hospital with complaints of burns to the left chest, left waist, left arm, and right hand.
The patient was injured by the explosion of the generator engine, which hit the patient's left arm and all the fingertips of his right hand. The incident took place in an open space. Patients did not get complaints of hoarseness, shortness of breath, or soot in the nose and mouth. When he arrived at the hospital, the patient was cleaned and treated for burns. The patient said it was very painful when the patient's wound was cleaned. The patient was allowed to be an outpatient and went home. 2 days after receiving treatment, the patient's wound became severe; namely, the patient's wound became more painful and blistered and started to secrete fluid, so the patient took the initiative to go to the hospital to get further burn treatment.
The patient said he was worried and afraid when he heard that the patient was going to have a debridement done. The patient imagines how much pain the patient will feel if the wound is treated so that the patient feels a pounding chest, shaking hands, and sweating. The patient said the pain increased when the patient saw the wound being opened, and the patient saw the wound, so the patient looked away while the wound was being cleaned. Patients sometimes have a lot of negative thoughts at night; patients think a lot about the worst scenario about their illness, such as amputation if their complaints don't improve. The patient feels anxious and alone because when in the isolation room there is no one for the patient to talk to and exchange ideas with. The patient said that the illness he was experiencing at this time was a disaster because of the patient's own fault, who was negligent at work, so that in the future the patient must be more careful when working. The patient said that he had resigned and hoped that the wounds on his chest and hands would immediately receive treatment and heal.
The patient has never had any other serious physical illness and has never experienced a mental disorder before. The patient is a hard worker, quiet and introverted, often gives in to avoid conflicts with others, tends to think of small problems easily, and rarely shares problems with others because he doesn't want to be a burden.
According to the patient and family, what he is experiencing is a disaster that must be faced, even though it feels so hard for the patient; the patient believes there will be wisdom behind this incident.
Methods
1. Physical
- Examination of vital signs, namely conscious awareness, blood pressure 120/82 mmHg, pulse 82x/minute, respiratory rate 18x/minute, and temperature 36.2 degrees Celsius. Obtained deep dermal combustion covering the left auricular region, thoracoabdominal region, thoracolumbar region, and left superior extremity region with a total of 24%. BMI: 19.05 kg/m³. From laboratory tests, it was found that there was a decrease in albumin (2.58) and Hb (10.6). Diagnosis: Combustio severe deep dermal full thickness 24% et causa fire.
- The patient was given an injection of metamizole 3x150 mg intravenously and an injection of ceftazidin 2x300 mg intravenously. Patients are also subjected to regular debridement and wound dressings. In Medical Rehabilitation, proper anti-contracture positioning was carried out after burns to the extremities. The VAS score for pain assessment is 7.
2. Psychiatry
- Psychiatric status obtained clear composmentis awareness, relevant fluent verbal contact, depressive mood/affect, realistic thought form, coherent thought content, worry about the future, normal perception and will, and limited hypoactive psychomotor. The DASS-21 results show a stress score of 14 (mild), an anxiety score of 18 (severe), a depression score of 10 (mild depression), and a HAM-A score of 26 (severe). The patient is in the acceptance phase (Kubler-Ross), where the patient is able to accept the condition of his illness, but the patient is still anxious when the wound cleaning procedure is carried out.
- Multiaxial diagnosis
- Axis I: Adjustment disorder characterized by a combination of anxiety and depression (F43.22)
- Axis II: avoidant anxiety personality traits
- Axis III: Severe degree of deep dermal full-thickness combustion of 24% et causa Api
- Axis IV: Problems with medical conditions and work problems
- Axis V: GAF scale hospitalized 50, best in the last 1 year 80.
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