How EMDR Can be Used to Treat Chronic Pain

EMDR may have started as an effective trauma modality. Recently, research and clinical observations have shown effectiveness in treating chronic pain that either is associated with trauma or is not.

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a therapeutic modality designed to help people overcome traumatic events and other distressing situations. EMDR is a structured therapy that encourages the patient to focus briefly on a distressing symptom or trauma memory while simultaneously experiencing bilateral stimulation (traditionally eye movements, but also can include tones, tapping, and somatic techniques), which is associated with a reduction in the intensity and emotion associated with the trauma memories. Research has shown that EMDR therapy is effective in helping people recover from trauma and PTSD symptoms. It is also effective for chronic pain, anxiety, panic attacks, OCD, depression, addictions, and other distressing life experiences.

EMDR therapy is a process in which the therapist prepares the client with appropriate resources, skills, and techniques to be able to do the processing of EMDR. During the processing, the therapist acts as a guide and safety net, helping the client desensitize and overcome the dysfunctional or traumatic material that has been holding them back.

What is Chronic Pain?

Chronic pain is essentially pain that continues after an injury is healed or should be healed. It can occur without injury or with other injuries that never fully heal. Usually, it is not considered chronic pain unless the pain has been persistent for three months or more.

Chronic pain is different from acute pain and needs to be treated differently. The nervous system is much more involved in chronic pain. Additionally, it is often increased or caused by an overactive nervous system. The body uses pain to alert you to danger. Still, for many with chronic pain, the alert system is extra sensitive and either overreacting to stimuli or reacting to stimuli that are not dangerous. Moreover, the level of pain that someone experiences with chronic pain is often representative of the amount of perceived danger versus safety that their brain interprets. Trauma can influence this interpretation by the changes it causes in the brain and its hypervigilance to danger, although often incorrect.

Chronic Pain and EMDR

Several therapeutic factors and interventions can powerfully influence the brain’s decision to think that the body is in danger or at risk of damage. Chronic pain can be due to misinterpretations in the brain, and EMDR can correct these misinterpretations. 

AIP Model and Chronic Pain

EMDR works by activating adaptive information processing through bilateral stimulation. The Adaptive Information Processing (AIP) model, which is the theory behind EMDR, theorizes that earlier life experiences that are maladaptively stored in the nervous system are involved in triggering the present pathology. This pathology would include psychological symptoms such as fear and distress as well as physical sensations such as pain. The underlying traumatic or painful memories may serve to cause, maintain, or increase the pain response to current stimuli, even if the current stimuli are not actually painful. It has been hypothesized that EMDR desensitizes the emotionally augmented portion of the pain experience. Emotionally, pain and physical pain are activated in the same parts of the brain.

EMDR was developed to address the distress resulting from traumatic memories. It is probable that targeting the affective distress alongside the distressing events that are coupled with the pain brings about improvement of the pain. Affective distress can be an emotional component of pain, just as pain can be a consequence of affective distress. 

The Therapist’s Role in Treating Chronic Pain with EMDR

The therapist’s confidence is critical in helping the client believe that pain relief is possible. The better the therapeutic relationship, the more likely EMDR is to work effectively. The therapist provides psychoeducation, explains why they believe the client is able to recover, and enables the client to accept what has happened so that they become more open to change. The mere expectation of pain relief is enough for the brain to release its own opioids.

The person providing treatment considerably impacts the pain relief of the person receiving it, and giving a clear explanation before treatment makes a big difference, too. The opposite is also true: ‘I’m not sure this is going to work’ can trigger anxiety that releases neurotransmitters that can open the floodgates for pain.

Stress’s Influence on Pain

Stress can be a driver of pain, so reducing stress is essential in reducing pain. Anticipation of future pain or memory of past pain contributes to stress, and anxiety can influence the brain’s interpretation of pain. Addressing and processing underlying trauma can help reduce pain intensity in the here and now.

EMDR and the Emotional Aspects of Chronic Pain

Pain treatment represents a promising and recently growing field for the use of EMDR therapy. Psychotherapeutic care of patients with pain has long focused on their dysfunctional coping strategies and maladaptive behaviour patterns. However, the significant influence of stressful life events and/or emotional stress on pain perception and central pain processing has been neglected. In addition to the purely sensory dimension, physical pain usually contains a substantial emotional dimension. This emotional dimension not only determines the levels of intensity and/or stress with which pain is experienced, but it can also contribute significantly to the maintenance of pain symptomatology. This “emotional” shift is held responsible for the fact that pain, similar to “flashbacks” in posttraumatic stress disorders, settles in and is unable to disappear.

How Can EMDR Be Used for Chronic Pain

EMDR Standard Protocol

The standard protocol is the primary EMDR protocol that focuses on the memories behind the pain. Clients are asked to focus their attention on disturbing pain-related or traumatic memories and the associated thoughts, feelings, and somatic sensations while focusing on an external bilateral stimulus such as eye movements, tapping, or alternating tones.

EMDR Pain Protocol

The EMDR Pain Protocol developed by Mark Grant draws heavily on practices from Sensorimotor Psychotherapy. In Grant’s protocol, there is a direct focus on the pain being experienced in the here and now. The pain intensity is described in terms of subjective units of pain, and the use of EMDR processing aims to bring the intensity down.

The EMDR Pain Protocol is ideal for chronic pain associated with trauma, as EMDR was developed and proven effective as a trauma treatment. However, the protocol has also been effective for chronic pain not associated with trauma. EMDR can work on the maladaptive aspects of chronic pain to reduce suffering. People have experienced substantially decreased pain levels, decreased negative affect, and increased ability to control their pain following treatment.

What are the Benefits of Using EMDR for Chronic Pain?

EMDR therapy for chronic pain involves focusing on pain-related memories, current pain sensations, or anticipated stressful or painful situations while engaging in bilateral stimulation. Focusing on these thoughts while engaging in bilateral stimulation may reduce pain intensity. In some cases, the pain relief from EMDR may be enough to reduce or eliminate pain medications. It may also improve mood, reduce disability, and help reduce symptoms of depression and anxiety. Maximum pain relief generally occurs with a minimum of six to eight EMDR sessions.

Pain that is related to psychological trauma, pain that can be processed  “trauma-therapeutically,” and pain triggers can benefit from EMDR. Most studies used the standard EMDR protocol to focus on the processing of traumatic memories associated with pain; special attention is often paid to the processing of pain-associated fears, as well as to enabling changes in pain sensations and developing new coping strategies based on these changes.

EMDR has been effective for a wide variety of pain conditions, including:

• Phantom pain
• Headache
• Acute postoperative pain
• Fibromyalgia
• Chronic musculoskeletal disorders
• Irritable Bowel Syndrome
• Migraines
• Non-specific chronic back pain
• Rheumatoid arthritis

Conclusion

EMDR can be an effective treatment for chronic pain. It works by moving dysfunctional memories and interpretations in the brain into adaptive networks, which can reduce or eliminate chronic pain. It can also be a powerful treatment for reducing the emotional aspect of chronic pain.