Hypnosis for CRPS: Can my pain simply disappear?

Recently, somebody asked me whether hypnosis could treat CRPS pain. After all, it’s long been in the armoury of those treating phantom limb pain. However, in such cases, it’s controversial due to the inevitable but wholly wrong suggestion that amputees somehow imagine their pain, so-called all in mind. Here’s a closer look at the available evidence for the use of hypnosis for CRPS.

Hypnosis for CRPS

Some years ago, I acted for a client with therapy-resistant CRPS in his left lower leg and foot. He had undergone the full panoply of treatments. That included the implantation of a spinal cord stimulator, alas, with little effect on his levels of pain. In desperation, he sought a below-knee amputation. In that context, he saw a psychologist regarding hypnosis for possible phantom limb pain.

That got me thinking. Some of my clients undergo hypnotherapy as part of more general coping strategies for CRPS. So, I wondered, is there any published research on its broader efficacy as a treatment tool? The answer is yes – a little.

First, it’s crucial to understand that CRPS is a physical condition with objective signs, and, as with phantom limb pain, it’s not all in the mind. But despite its physical basis, CRPS also has a psychological or behavioural component. That’s why simple tools such as mirror boxes can produce incredible results in a few cases. Might hypnosis also prove effective as part of a multi-disciplinary approach to treatment?

Dr David Flemming

I discovered a fascinating article [unfortunately, now removed] on the work of Dr David Flemming, MD of Massachusetts. Dr Flemming’s well-known studies of hypnosis and CRPS began in the 1990s, and most other research in this area references his work.

Dr Flemming discovered that for some people with CRPS, hypnosis can help reduce symptoms or even, in a few cases, achieve remission if used as part of a multimodal approach to treatment. It’s well known that some people are more susceptible to hypnosis than others. After all, that’s why stage hypnotists choose their subjects with care.

In terms of the mechanism at work, the theory is that images generated in the subject’s mind through hypnosis can somehow alter the function of the autonomic nervous system. Crucially, Dr Flemming stresses that “a lay hypnotist can cause serious damage by attempting to coax remission without addressing the [related] psychological issues. This work requires extreme skill and must be taken very seriously.”

Hypnosis for CRPS: the most recent study

In 2017, the journal Hand Surgery and Rehabilitation published the results of a small-scale study, “Physical therapy under hypnosis for the treatment of patients with type 1 complex regional pain syndrome of the hand and wrist: Retrospective study of 20 cases”.

As the title suggests, the study aimed to assess the effectiveness of physical therapy on the CRPS-affected hand and wrist whilst under hypnotherapy. All patients were in the relatively early stages of the condition, and the results were impressive. Patients saw a reduction in pain, function and analgesic use after, on average, 5.4 sessions. And “return to work was possible in 80% of the cases.”

In conclusion, the researchers reported, “All patients were satisfied or very satisfied with the treatment. Physical therapy under hypnosis appears to be an effective treatment for CRPS-1 at the wrist and hand no matter the etiology.”

However, before everyone begins rushing to find their local medical hypnotist, there are a couple of obvious red flags. First, the study was very small-scale. Second, as the subjects were in the early stages of CRPS, statistically, some may have achieved remission in any event.

That said, viewed alongside Dr Flemming’s research, the results support the need for larger-scale studies. Of course, the sceptic in me says that as a non-pharmaceutical therapy, it’s not research that the drug companies’ deep pockets will fund. That may also go some way towards explaining the current dearth of material on this subject.