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

4. 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

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

6. What I ended up with 8 papers (12 discarded) 67 participants
Drop-out: 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 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

7. 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

8. 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)

9. 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.

10. 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)

11. 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?

12. 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

13. 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)

14. 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 ?