Use of Hypnotic Analgesia for the Management of Postmastectomy Pain Syndrome

Abstract

A 57-year old woman presented with a complaint of pain on the left chest wall, incision scar area, axillae, upper forearm and limitation of motions at left shoulder for 4 years. She was treated under the diagnosis of postmastectomy pain syndrome. Pain was constrictive, myalgia in characters and the visual analog scale was 4. She said that the pain was worse when tired and fatigued, but relieved when in the bath. Associated symptoms were not found. A cervical epidural puncture (C6/7) was performed and 1 % lidocaine with triamcinolone was injected. Gabapentin 300 mg daily was also given. Tender points injection with 0.5% bupivacaine and dexamethasone was performed several times. Stellate ganglion block with 1 % lidocaine was also included once in the treatment regimen. On the second visit at the outpatient clinic, she showed fairly good signs of relief of pain and limitation of motions, but still remained anxious and complained of feeling of anger, frustration, and a feeling of loss and suffering. Hypnotic analgesia was indicated. Two sessions (1 hour for one session) were scheduled in a quiet room. Feelings of magnetic power on both palms were used as an induction technique and imagination on escalator was adopted for the deepening hypnosis, arm levitation for dissociation, a warm feeling of body for changing sensation, progressive relaxation, symbolic imagery for posthypnotic suggestion (turning the radio button) and glove analgesia technique were tried. Self-hypnosis and ego-strengthening were instructed for further pain relief. After the treatment, she was quite satisfied due to reduction of pain and stabilization of mind.