The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance - often on a daily basis for weeks to months - of painful and anxiety-provoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by potent pharmacologic analgesics (e.g., opioids), but is necessarily complemented by nonpharmacologic techniques, including distraction or hypnosis. Immersive virtual reality provides a particularly intense form of cognitive distraction during such brief, painful procedures, and has undergone preliminary study by several research groups treating burn patients over the past decade. Initial reports from these groups are consistent in suggesting that immersive virtual reality is logistically feasible, safe and effective in ameliorating the pain and anxiety experienced in various settings of post-burn pain. Furthermore, the technique appears applicable to a wide age range of patients and may be particularly well-adapted for use in children, one of the most challenging populations of burn victims to treat. However, confirmation and extension of these results in larger numbers of patients in various types of burn-related pain is necessary to more clearly define the specific benefits and limitations of virtual reality analgesia in the burn care setting.

Expert Rev Neurother. 2008 Nov;8(11):1667-74. Sharar SR, Miller W, Teeley A, Soltani M, Hoffman HG, Jensen MP, Patterson DR. Department of Anesthesiology, Harborview Medical Center, Seattle, WA 98104, USA. sharar@u.washington.edu

The Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C), developed and named 37 years ago, is arguably the "gold standard" of hypnotic susceptibility scales. However, it has been the impression of several researchers that means obtained on the SHSS:C are higher now than in previous years. The authors comprehensively review studies using the SHSS:C over a 4-decade period. The findings demonstrate a significant linear trend between year and SHSS:C scores, with higher obtained means in more recent work. The authors also report a similar analysis of research with the Harvard Group Scale of Hypnotic Susceptibility, Form A. Although the mechanisms underlying this trend can only be speculated upon at present, these findings underscore the importance of using local control groups in research on hypnotizability.

Benham G, Smith N, Nash MR. Department of Psychology, The University of Tennessee, Knoxville 37996-0900, USA. britpsyc@utk.edu