THE ROLE OF HYPNOSIS IN PROCEDURAL PAIN MANAGEMENT DURING BRONCHOSCOPY: A CLINICAL CASE

F. Stivala, V. Buffa, V. Ficarra, B. Carbone, M.R. Pescuma, M. Viale, C. Schierano, A. Lombardo, D. Coggiola, M. Paleologo | A.O.U. City of Health and Science of Turin, Molinette Hospital

BACKGROUND
Bronchoscopy is a diagnostic and therapeutic procedure often associated with patient discomfort, anxiety, and pain. In recent years, integrated approaches to pain and stress control have highlighted the effectiveness of clinical hypnosis as a complementary, non-pharmacological technique. The use of hypnosis in the context of bronchoscopy may improve patient experience, reduce the need for sedatives, and enhance procedural compliance.
METHODS
A 64 year old female patient with adenoid cystic carcinoma of the trachea and tracheal stenosis had previously undergone palliative endoscopic debulking and placement of a Y-shaped tracheal stent. In October 2024, she underwent an initial diagnostic bronchoscopy, prepared with local anesthesia using 1% oxybuprocaine and intravenous pharmacologic sedation with 5 mg midazolam and 50 µg fentanyl. In January 2025, the patient underwent a follow-up bronchoscopy. A preliminary informational interview was conducted, and informed consent was obtained. The bronchoscopic procedure was then performed under hypnosis, in combination with local anesthesia using 1% oxybuprocaine. If necessary, pharmacological sedation with midazolam and fentanyl was administered.
RESULTS
In the two inspection bronchoscopic procedures performed on the same patient, the follow-up bronchoscopy conducted under hypnosis involved the combined use of local anesthesia with 1% oxybuprocaine and 1 mg midazolam, alongside hypnotic treatment. This integrative approach proved more effective in managing procedural pain and discomfort compared to the initial procedure, which involved only pharmacological sedation (5 mg midazolam + 50 µg fentanyl). A post-procedural interview revealed a significant improvement in the patient’s subjective experience: she reported complete relaxation and absence of pain, expressing satisfaction and willingness to undergo the same technique again. “I was with my family, I was thinking about my breathing, I felt great, I’m happy I tried this technique, I would do it again; the other times it was more difficult to relax, even with sedation I felt discomfort, but this time I didn’t feel any pain at all—zero pain.”
CONCLUSIONS
This clinical experience highlights how integrating hypnosis with local anesthesia during bronchoscopy may offer valid support in managing procedural pain and anxiety. In this case, hypnosis significantly improved the patient's perception of well-being and reduced the need for pharmacologic sedation, thereby minimizing potential side effects. These preliminary results support the potential of hypnosis as a safe and effective complementary technique, promoting a more patient-centered approach in invasive procedures such as bronchoscopy. Further studies are needed to strengthen the scientific evidence and develop standardized operational protocols.