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 EMDR & Chronic Pain

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a non-traditional form of psychotherapy that aims to alleviate symptoms of distress that are borne from post-traumatic stress disorders (PTSD), depression, chronic pain, and other debilitating conditions (Shapiro, 1989). EMDR bases its principal tenets on Shapiro’s (2002) Adaptive Information Processing model as an underlying theoretical framework. Essentially, the model states that symptoms of PTSD and disorders such as depression stem from the brain’s inability to integrate and process disturbing experiences adequately. When this occurs, the unprocessed experiences generate memories associated with distressing emotions, thoughts, beliefs and physical sensations.

 

TREATING CHRONIC PAIN WITH EMDR

 

Pain which persists beyond normal healing time-frames, or chronic pain, is different. Chronic pain usually starts with an injury or illness, but is greater than would be expected for the injury that caused it and it doesn’t respond to normally effective treatments. Chronic phys- ical pain comes in many different forms, including:

  • Back pain

  • Cancer

  • Complex Regional Pain Syndrome

  • Fibromyalgia

  • Sciatica (irritated nerve causing leg pain)

  • Somatization Disorder

  • Migraine pain

    Chronic pain involves a different mix of physical and mental symptoms than acute pain. Complex Regional Pain Syndrome (or Reflex Sympathetic Dystrophy) is caused by a distur- bance of the sympathetic nervous system; the network of nerves located along the spinal cord which controls bodily functions such as the opening and closing of blood vessels and sweat glands. Fibromyalgia involves increased sensitivity to pain, including touch (known as allody- nia) and fatigue in muscles and tendons. Complex Regional Pain Syndrome and Fibromyalgia are thought to be maintained by a combination of physical and psychological factors ranging from genetic predisposition to stress. Chronic pain is also processed differently in the brain with greater involvement of areas of the brain involved in memory and emotion than for acute pain.

  Psychological treatment of chronic pain has traditionally targeted the negative thoughts and behavioral changes that were thought to maintain pain. Recent discoveries in brain science have shown that while thoughts are important, chronic pain is primarily maintained by changes in brain activity associated with emotional processing. Basically, the brain is altered by experience, whether pain, injury, trauma (PTSD) or severe stress. The brain ‘learns’ pain-maintaining patterns of activity through repeated exposure to adversity, traumatic stress and illness/injury. So, a person whose brain has experienced a lot of severe stressed is already ‘primed’ to develop chronic pain following injury. In the sense that pain involves learned patterns of sensing and experiencing, it is a kind of memory; a body memory. Recognition of the role of brain functioning in chronic pain explains many aspects of chronic pain including why it can erupt spontaneously; why it can spread to regions of the body separate to the site of original injury; why it is more common in people who have previously endured severe stress and why it does not respond to normally effective medical treatments. It has also paved the way for new treatment approaches.

  EMDR (Eye Movement Desensitization and Reprocessing) emerged in the early 1990’s as a treatment for PTSD (Posttraumatic Stress Disorder). EMDR relies on stimulating brain regions responsible for sensory-emotional processing in a way that stimulates relaxation and new patterns of thinking. The method is thought to harness an innate information processing capacity that normally ‘files’ experience away as something that feels like it happened in the past, something that you have learned from and moved on from. Chronic pain and PTSD arise when the brain is unable to do this. EMDR re-activates your innate information processing via a process known as dual focus of attention / bilateral stimulation (BLS). During BLS you pay attention to your pain memory whilst simultaneously focusing on alternating auditory or visual stimuli. This creates a sensory experience that overrides the neural patterns that maintain pain and distress – without significant conscious effort. It’s the same process that occurs whenever you learn something new; relaxation followed by new perspectives. In the treatment of PTSD EMDR has been found to reduce physical and emotional distress permanently. Although individual responses may vary, research indicates that EMDR can also alleviate pain and associated distress, sometimes permanently.

  In practice EMDR looks and feels very different to traditional therapy. There is no extended talking about the past, no effort to consciously change your thinking, no graded activity programs. Once your therapist has assessed you as ready for the treatment, you just focus on the problem (painful feelings, distress) + BLS and your nervous system does the rest. Typically, you will experience a relaxation response and a feeling of distance from the painful feelings.  This is often the beginning of a permanent change in how you experience your pain. Once you start feeling better you will spontaneously start to re-engage with life in a way that is right for you.   

  Obviously you do not experience pain in isolation. It may be associated with injury, disability, lost physical functioning, unresolved emotional trauma and anxiety and depression. In many cases the effects of pain are compounded by intrusive third-party treatment mediators (eg; insurance companies) and even medical trauma. Pain management thus requires addressing all of the various emotional, social and existential elements of this problem. In all but the simplest cases of trauma-related pain, treatment is likely to involve additional inputs targeting pain (eg; guided imagery, body-centered psychotherapy) other pre-disposing trauma (eg; attachment-focused psychotherapy) and psycho-neurological changes (eg; brain-reprogramming exercises). Treatment is thus individual, phased, multi-faceted, and usually long-term.

Six things you can do right now to start feeling better

By Mark Grant, MA

Pain is maintained by a combination of sensory-emotional processes which are often outside of conscious control. The best way to overcome pain is to reverse the sensory-emotional pat- terns which maintain it. Below you will find six relatively straightforward strategies which are designed to appeal to the sensory-emotional part of your nervous system, where pain and stress are mainly stored. If you adopt one or more of these strategies today, you will have begun the process of reversing your pain and feeling better.

  1. Make peace with your feelings. Know that feelings such as anger, fear and denial are normal reactions to pain and start using them as a resource. For example, if you feel anxious, try and listen to your anxiety and what it’s trying to tell you. Maybe you need to talk to someone. If you feel depressed, acknowledge your feelings of fatigue and helplessness and lower your expectations of yourself.

  2. Don’t judge things. Start looking at events from an emotionally neutral standpoint. Try and see your pain as a purely physical phenomenon rather than judging it as good or bad. This is hard but it will take the emotional sting out of your pain.

  3. Learn how to relax. Sit or lie in a comfortable place and concentrate on your breathing or some other soothing stimulus. For that 10 or 20 minutes, give yourself permission not to worry, think or plan. If any negative thoughts come into your mind, just let them go, like leaves blowing in the wind, and return to your relaxation.

  4. Do something that changes how you feel! Engage in an activity that arouses your curiosity/interest/excitement – take a trip, start a hobby, learn a new skill, see a show, take up meditation. Regular exercise is one of the cheapest, most effective forms of stress-management around. If conducted in a graduated, paced fashion, it is also ben- eficial for chronic pain.

  5. Do whatever you do that makes you feel better repetitively. The more often you stim- ulate positive feelings, the more chances you are giving your nervous system to learn new ways of feeling.

  6. Change your sleeping routine. Pain and stress will affect your sleep cycle and fatigue is a major exacerbating factor for pain. Rather than trying to force your body into a nor- mal sleeping routine, accept that your sleeping routine isn’t going to be normal and if possible just sleep when you feel tired, regardless of the time. Although inconvenient, you will at least get more rest and this will improve your ability to cope.