Reflex Sympathetic Dystrophy

Outcome resulting from the integration of hypnosis with management for reflex sympathetic dystrophy (RSD) is reported in forty-one patients considered to be refractory to treatment. Eighty-five percent demonstrated a high hypnotic capacity. Fifteen percent had a low hypnotic capacity. None demonstrated average hypnotic capacity. Patients with high hypnotic capacity were able to alter labile features and other physical manifestations of the disease. With continued use of hypnosis as part of an integrated treatment program, 60% of the sample gained long-term remission. Remission is defined here as absence of pain, or presence of mild intermittent pain that patients were able to relieve using self-hypnosis. Patients in remission were able to return to work. Results show patients grouped at either end of the scale ofhypno-tizability. Since people at these two extremes characteristically suffer from widely differing psychological problems, this outcome report supports the absence of psychological precedents for RSD. The neurological and behavioral patterns of RSD may become adopted as the physiological signature of a dissociated ego-state. We propose a paradigm for the disease that suggests that the behavioral and psychological impact of RSD becomes a critical maintaining factor. Also, remission is possible for the majority of sufferers if this impact receives adequate treatment, provided the patient is able to moderate autonomic function with therapeutic imagery.