Use of Hypnosis for Intra-Articular Steroid Injections in Children with Juvenile Idiopathic Arthritis

Objectives Intra-articular steroid (IAS) injections are a common treatment for Juvenile Idiopathic Arthritis (JIA) but can cause anxiety in children, particularly due to needle fear. To facilitate cooperation, general anesthesia is often used for younger children or those requiring multiple injections. Older children undergoing 1 or 2 joint injections may stay awake, sometimes with optional midazolam sedation which requires post-procedure monitoring. Hypnosis offers a non-pharmacological alternative to reduce anxiety and distress.[1] By inducing a natural altered state of consciousness, characterized by focused attention and reduced peripheral awareness, hypnosis enables children to focus inward and ignore external stimuli.[2] Unlike sedation, hypnosis does not require post-procedure monitoring, allowing for quicker recovery and discharge. We report our experience using hypnosis to manage pain and anxiety during IAS injections in a tertiary care rheumatology clinic.

Methods Since March 2020, a nurse trained in hypnosis has offered this technique to children undergoing IAS injections. To evaluate its impact, children provided feedback using visual analog scales (VAS) and personal reflections.[3] Procedure difficulty score was rated from 0 (no difficulty) to 10 (maximum difficulty), and perceived benefit score from 0 (no benefit) to 10 (maximum benefit). During the same period, children receiving IAS injections with other supportive strategies completed the same scales and shared reflections. Feedback was collected post-procedure by the same nurse who supported each child using their chosen method.

Results Data was collected on 80 procedures in 62 children: 55 procedures with hypnosis, 25 using other strategies (phone distraction (7), music (4), conversation (4), midazolam (2), breathing techniques (4) or no specific intervention (4)). Groups were comparable for age, gender and joint injected (Table 1). All children successfully completed the procedure. Children in the hypnosis group reported lower procedure difficulty and higher perceived benefit compared to those with other methods. Overall, children voiced that hypnosis helped them focus on their chosen experience and not on the procedure, while children using other methods expressed more physical sensations. Clinicians observed a calming effect with hypnosis contributing to better procedural tolerance.

Conclusion Children consistently report hypnosis as helpful. Hypnosis provides a compassionate way to accompany children in a challenging moment. It helps them stay engaged, feel capable, and actively participate in their own care.

References [1.] Geagea D. Pain Med 2022;24:661-702. [2.] Tran L. Front Pediatr 2021;9:719626. [3.] Gift A. Nurs Res 1989;38:286-7.