1. Hypnosis in the treatment of Complex Regional Pain Syndrome
Annie Hopkins
Clinical Psychologist
SASH Diploma of Clinical Hypnosis 2017

2. Introducing “Ms H” 57 year old woman, referred by pain consultant
Passenger in a head-on car accident three years prior
Right shoulder injury, surgery to repair rotator cuff tear
Subsequent development of Complex Regional Pain Syndrome (CRPS) in her right hand, in addition to ongoing shoulder pain
Depression, anger, suicidal ideation
Sleep disturbance
Relationship strain

3. Complex Regional Pain Syndrome
Usually confined to a limb or limbs; occurs after minor injury or frank nerve injury
Severe pain, out of proportion to the injury
Signs and symptoms: Allodynia, hyperalgesia, swelling, sweating, temperature changes, skin colour changes, hair and nail growth changes
Often also changed perception of the limb: it doesn’t belong, perceived as larger than it is
Cause: unknown. Possible wind-up of inflammatory response. Central and peripheral nervous system changes.

4. Ms H’s CRPS pain Hand was “on fire” intermittently
Allodynia: exquisite pain with light touch
Pain episodes were “like an earthquake: when it starts, you don’t know if this is the one that is going to keep going or is just a brief tremor.”
Pain increased when looking at her hand -> avoidance
Perceptual disturbance: hand doesn’t belong to me
Shoulder pain different: musculoskeletal ache

5. Social Originally from USA
Third husband, travelling around Australia to find retirement location
Now living in mobile home in outskirts of Adelaide
Unable to work: previously very active with own businesses
Worried about dipping into retirement savings
Frustrated at loss of independence

6. Psychological Other treatments Depressed mood
Post Traumatic Stress Disorder (PTSD) re the car accident
Anger re the other driver
History of childhood sexual abuse until age 12
Other treatments
Physiotherapy: desensitisation, graded motor imagery, mirror box
Ketamine infusions, Endep, Lyrica
Further surgery for shoulder planned

7. Treatment overview Session 1: pain education
Session 2: hypnosis for pain management
Speigel induction; ideomotor signalling
Protective suggestion: focus only on what was helpful for soothing her physical hand and arm pain; any other information able to be put safely away
Special place: beach, absorbed in sensory experience
Suggestions re warmth of sun; soothing, pain-relieving chemicals washing through her nervous system
Anaesthetic glove
Session 3: sleep hygiene and hypnosis for sleep
Session 4: review and temporary termination of therapy

8. Outcomes
Ms H pleased with hypnosis experience and had increased confidence in it
Less fearful and avoidant of pain
Reduced pain medications
Better stress management and able to halt the escalation of pain
Improved sleep
A combination of therapies contributed

9. Future therapy Imagery of “fire” and “earthquake”
Resolution of anger towards the driver
Prolonged imaginal exposure for PTSD symptoms

10. Thank you… Questions?