Chronic Regional Pain Syndrome and 5-PATH®

by Penny Chiasson, CRNA, BCH, CPHI

Working with clients diagnosed with various pain syndromes can range from extremely gratifying to extremely frustrating. When choosing to work with a client who has a chronic pain syndrome, the key is to identify those clients best to work with. I do this using a custom evaluation tool I created (based on research and other pain tools) that identifies behaviors or beliefs that can negatively impact their outcome. During our booking call I decide if this particular client is someone I can help based on their responses to my questions. In addition to the evaluation tool, a commitment to showing up for appointments and flexibility to get those appointments as close together as possible is a factor in my decision.

Chronic Regional Pain Syndrome (CRPS) clients can be very challenging. CRPS is a form of chronic pain that usually affects an arm or a leg. CRPS typically occurs after an injury or surgery, but can be from something as simple as an IV placement or stubbed toe. The pain is out of proportion to the severity of the initial injury, and diagnosis is usually delayed by primary providers. The more delayed the diagnosis, the more difficult to treat using conventional methods.

When using hypnosis in CRPS, subconscious reprogramming is very important. Neuroplasticity allows us to assist the client in creating new pathways regarding ways of feeling. In a moment, I will go into the 5-PATH® component, but be sure to have some good direct and indirect suggestion scripting. Metaphor also works well, and I like to create a bind in my pain clients. In the evaluation I ask them about how much more they would be able to do if they are 30, 50, or even 75% more comfortable. Then I use those levels of comfort to bind the subconscious as to how much more comfortable the client can be after a session. If you have never used a bind before, be sure to read up on it before hand.

5-PATH® in CRPS is consistent with the systematic approach you are already using. Usually I plan a couple of DS sessions before proceeding with AR. This is because I want to see what beliefs and behaviors remain after gaining the client some comfort and what situations cause any increase in pain while we are working together. Symptom bridge can be very effective, particularly if a specific symptom worsened due to stress, or feeling. When working on negative beliefs or behaviors, pay particular attention to a behavior called ‘catastrophizing’. This is when the client makes statements like “Oh my God, THIS IS KILLING ME!”, or “I just can’t take this anymore”. Some clients will make these statements once in a while, for others, it is their mantra. For those clients, helping them to eliminate ‘catastrophizing’ not only leads to consistent reductions in pain, but also has bern shown to reduce symptoms of depression and anxiety.

This brief article only scratches the surface of the topic of CRPS. When working with chronic pain, I recommend being able to provide a comprehensive approach including stress reduction techniques, mindfulness techniques (when the conscious mind is engaged, pain scores are reduced), providing an audio of one of their DS sessions to listen to on repeat as often as possible, and using 5-PATH®. When using 7th Path Self-Hypnosis® work with them on crafting their 5th recognition in the full form so they get continued progress. While some clients gain significant immediate relief, it may take weeks or months of “staying in the process” to gain the maximum benefit, especially if they have experienced muscle atrophy and are engaging in physical therapy to regain function.

To learn more about CRPS you can visit https://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/symptoms-causes/syc-20371151