A systematic review of the use of EMDR in supporting people with chronic pain Kim Patel

My study in context: Why was it done? How does it relate to previous Course requirement “Nye” and the link to PTSD How does it relate to previous research? PTSD & CP co-occurrence Self concept in chronic pain (CP) Aim for this presentation

Can CP be effectively treated using EMDR? Why choose a systematic review? The process of finding pa papers Limitations of this research approach

What I ended up with 8 papers (12 discarded) 67 participants Drop-out: 16 + 6 at F/U. Reasons: death, improvement, distance to clinic, pension threat due to improvement, getting time off work to attend clinic. 8 papers (12 discarded) 67 participants CP-3, PLP-20, Fibro +/- CFS – 10, Headache-30 neuropathic -4 All used pre-test/post-test design. 2x case study, 4x case series, 2x uncontrolled clinical trials Follow-up data in 25 participants at 2-3mths & 3 years 47 female, 20 male aged 25-67. Pain duration 1 week* to 20 years PP EMDR = 41, SP EMDR = 10 Hybrid (PP & SP)= 10 Not identified EMD = 6 47 participants taught EMDR/EMD components for home use No rationale for number, frequency, length of sessions except for 10 participants where end-criteria were fulfilled

Findings Pain score reduction is rapid (2 – 15 weeks) Opiate and other analgesia frequency/dose reduced Length of time of CP irrelevant to pain reduction

Graph 1: Total pain scores pre-post- EMDR comparing CP to PLP PLP n=18 CP n=20 (numerical data not available for every participant)

Graph 2: Total pain scores pre- post- EMDR standard VS pain protocol SP n=18 PP n=47 PLP=SP CP=PP (Hybrid protocol put into SP) BOTH GRAPHS ARE IDENTICAL PLP responds better to SP EMDR than CP does to PP EMDR.

Data analysis SP & PP EMDR effective in pain reduction Unable to say if SP more effective than PP (no PLP PP studies) CP & PLP used different primary targets e.g. PLP = trauma-related memory using SP CP= pain sensation using PP 2 participants fulfilled criteria for PTSD (DSM-IV-TR) → EMDR SP effective without PTSD in a CP condition One paper identified forgotten traumas during EMDR treatment (SP PLP n=5)

Weaknesses in the evidence My findings dependant upon quality & quantity of primary studies Small number of studies & not able to obtain 2 Incomplete reporting in primary source Studies of varying method & of varying quality – synthesis difficulties Representative sample? CP participants heterogeneous (type and origin of pain)-representative? PLP participants homogeneous (limb lost through traumatic event) Gender (female 47:20), ethnicity (?) Variables/bias Could change have occurred outside of EMDR (variables not controlled) How much “bracketing off” is possible?

Implications for practice EMDR as an alternative treatment in CP = Greater choice in self-management for CP sufferers (with and without traumatic elements to CP) EMDR practitioners can facilitate a real and lasting reduction in suffering. ALL practitioners-raise knowledge of EMDR & CP mechanisms and influence practice. Promoting psychological therapies in CP treatment inside/outside NHS The impact of EMDR on affect, behaviour, neuroplasticity and memory offers clients alternative ways to process memories, self and loss in CP

But I don’t use EMDR! Experience & evidence points to the following areas among others to work with: -Self-concept -Loss & grief -Fear -Thoughts (toxic) -The meaning of pain -Sexuality & practicalities of having sex (positions, comfort)

Conclusions Constant pain, fatigue and distress = traumatic event Small-t trauma of CP linked to loss of self, role, function, inability to work, family/marital stress EMDR desensitises automatic emotional response to pain and somatically stored memories related to pain onset = experiencing pain/reduced pain levels with less affective distress and increased perceived ability to learn adaptive strategies to improve condition Closer to the pre-pain self-concept ?