Abstract
Eye movement desensitization and reprocessing (EMDR)-an evidence-based approach to eliminate emotional distress from traumatic experiences-was recently suggested for the treatment of chronic pain. The aim of this study was to estimate preliminary efficacy of a pain-focused EMDR intervention for the treatment of non-specific chronic back pain (CBP). Randomized controlled pilot study. 40 non-specific CBP (nsCBP) patients reporting previous experiences of psychological trauma were consecutively recruited from outpatient tertiary care pain centers. After baseline assessment, patients were randomized to intervention or control group (1:1). The intervention group received 10 sessions standardized pain-focused EMDR in addition to treatment-as-usual (TAU). The control group received TAU alone. The primary outcome was preliminary efficacy, measured by pain intensity, disability, and treatment satisfaction from the patients' perspective. Clinical relevance of changes was determined according to the established recommendations. Assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. Intention-to-treat analysis with last observation carried forward method was used. Registered with http://ClinicalTrials.gov (NCT01850875). Estimated effect sizes (between-group, pooled SD) for pain intensity and disability were d = 0.79 (CI95%: 0.13, 1.42) and d = 0.39 (CI95%: -0.24, 1.01) posttreatment, and d = 0.50 (CI95%: 0.14, 1.12) and d = 0.14 (CI95%: -0.48, 0.76) at 6-month follow-up. Evaluation on individual patient basis showed that about 50% of the patients in the intervention group improved clinically relevant and also rated their situation as clinically satisfactory improved, compared to 0 patients in the control group. There is preliminary evidence that pain-focused EMDR might be useful for nsCBP patients with previous experiences of psychological trauma, with benefits for pain intensity maintained over 6 months.
Highlights
Chronic back pain (CBP) is common and of socioeconomic relevance [1, 2]
As eye movement desensitization and reprocessing (EMDR) is directed to eliminate emotional distress that results from traumatic events, we focused on psychological trauma from specific events
The effects reported in our study suggested that EMDR treatment may satisfy patients’ success criteria and may offer sufficient pain relief for non-specific CBP (nsCBP)-t patients
Summary
Chronic back pain (CBP) is common and of socioeconomic relevance [1, 2]. For the individual patient, CBP is associated with serious disability and reduced quality of life [e.g., Ref. [1, 3]]. One explanation might be that psychotherapeutic attention paid to patients affected by pain had long focused mainly on cognitive-behavioral factors such as dysfunctional coping strategies and maladaptive behavioral patterns [14]. This neglected the fact that emotional distress, e.g., caused by psychological trauma, can have a central impact on the sensation and processing of pain [15,16,17]. The acknowledgment that pain can become chronic through maladaptive emotional processing forms the pathophysiological basis for applying eye movement desensitization and reprocessing (EMDR) [22] in treating chronic pain
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