Does hypnosis have the potential to help manage pain and anxiety during procedures?

Hypnosis may be helpful for select individuals when it comes to managing acute pain during dental procedures, reducing the anxiety associated with visiting the dentist, and alleviating chronic orofacial pain, according to a new Canadian study. Researchers at the Université de Montréal conducted a literature review, which was published in the American Journal of Clinical Hypnosis, and found evidence that hypnosis could and should be a useful complementary tool for oral health professionals. The team conducted systematic reviews and meta-analyses published between 2000 and 2024. There were 12 articles selected for analysis (eight studies on dental anxiety, three on temporomandibular disorders and one on burning mouth syndrome). The majority of the studies were from Germany, where hypnosis is already incorporated into some medical practices. Other countries included the United States, Denmark, Italy, China and India.“Our team was surprised by the abundant literature on hypnosis in a dental context,” said study investigator Angélique Thibault, a doctoral candidate in dental medicine at the Université de Montréal. “Hypnosis is an effective adjuvant for the management of dental anxiety and acute dental pain during operative dentistry treatment or dental extraction, for example. It can help lower the dose of sedation during an extraction and the analgesic intake afterwards.”Therapeutic hypnosis produces a modified state of consciousness in which the mind becomes more focused and receptive in order to promote relaxation and alleviate pain, according to Thibault. It is hypothesized hypnosis may be effective in managing acute pain during dental procedures, such as tooth extractions or cavity repairs under local anesthesia.The analysis showed that patients who had a tooth extraction under hypnosis reported less pain, resulting in reduced need for local anesthesia during the procedure. They also required less pain medication following the procedure. Further, hypnosis was found to be useful for pain relief during root canal procedures. “It helps manage anxiety, which can be noted by a stabilization of physiological parameters, such as blood pressure and heart rate,” said Thribault.The authors write that hypnosis may be an effective tool for alleviating “dental anxiety.” Studies show that it reduces anxiety before and during treatment, often outperforming methods such as audiovisual distraction. In children, hypnosis not only decreases crying and verbal resistance, but also helps stabilize heart rate.“For chronic orofacial pain, like temporo-mandibular disorders or burning mouth syndrome, findings tend to show a benefit of using hypnosis in the management of these conditions. Moreover, there is evidence-based support for hypnosis for other chronic pain conditions outside of dentistry, such as irritable bowel syndrome or knee osteoarthritis,” Thibault told the Medical Post. In dentistry, new primary standardized, randomized and dual-blinded studies are warranted. Thibault said for chronic orofacial pain, long-term followup studies would be necessary to assess the positive effect. Even with the numerous primary studies on the use of hypnosis, several types of dental conditions and treatments remain to be studied with the adjuvant hypnosis. This is particularly the case for endodontic treatments or periodontal or implant surgery. “The findings are clinically relevant because they indicate an interest in the research field that can eventually be transmitted in the clinical field. A conclusive research finding is a prerequisite for teaching and using hypnosis. With better understanding of the positive impacts and how it works, it will be easier to undo prejudices and to integrate this adjuvant in daily dental practice,” said Thibault.The research team conducted a survey in the summer of 2023 among Canadian dental faculties, and only two at that time had a brief hypnosis course in the undergraduate curriculum. Based on these findings, the faculty of dentistry at the University of Montreal is working on integrating a hypnosis curriculum in its undergraduate program. “It is essential that clinicians and the population understand that medical hypnosis is very different from show/stage hypnosis and that the patient does not lose control of its/her body, as many may fear,” said Thibault.Thibault attributes the lack of use of hypnosis in current dental practice in Canada to this insufficient training, noting that only two of the 10 Canadian dentistry faculties she consulted offer even a brief introduction to hypnosis in their programs. Hypnosis methods vary widely, from bringing in a professional hypnotherapist to using audio recordings to dentists performing hypnosis themselves. More rigorous studies with active control groups and detailed intervention descriptions are needed to strengthen the scientific evidence. To achieve this, Thibault advocates integrating hypnosis into university curricula so that future dentists are familiar with it and can even undertake research projects in this area. She said enhancing public awareness of therapeutic hypnosis is crucial. “Hypnosis is a serious medical tool, not just a spectacle for entertainment,” said Thibault. “With rigorous research and gradual integration into dental practice, hypnosis could one day become a standard tool in dental care, improving patient comfort and reducing the need for medication.”Dr. Annapurny Venkiteswaran, with the Centre For Paediatric Dentistry & Orthodontics Studies, in the Faculty of Dentistry University Teknologi MARA (UiTM) in Malaysia, said hypnosis is an additional tool which complements other non-pharmacological behaviour management techniques dentists traditionally use. “From my experience, it is able to provide the same anxiety relief that you would get from a session of laughing gas (nitrous oxide/oxygen sedation). Clinical hypnotherapy is also widely being used in the medical and surgical field as adjuncts to surgical procedures,” Dr. Venkiteswaran told the Medical Post.In dentistry, apart from alleviating anxiety, he has used hypnosis in helping patients with severe gag reflex undergo dental procedures. Being a paediatric dentist, he said he also finds it very effective in helping children overcome habits such as thumb sucking and nail biting. “Balloon juice and mumbo-jumbo are typically the first responses you would expect from other healthcare professionals or the general public as they confuse it with stage hypnosis, even I had my reservations when I first came across it. However, proper training using a well designed syllabus, ensures effective management of patients,” said Dr. Venkiteswaran.Dr. Gary Jacky, who has been practicing dentistry for more than 35 years in Seattle, said over the last three decades there, hypnosis has often been discussed at annual meetings. However, he said he could never find any compelling data to support its adoption. “I think it could help some people, but it depends on the individual,” he said.

Does hypnosis have the potential to help manage pain and anxiety during procedures?

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