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

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

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.

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

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

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

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

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

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

Thank you… Questions?