EMDR Therapy and Chronic Pain

September is Pain Awareness Month. We wanted to learn more about using EMDR therapy to treat chronic pain.

EMDR Therapy and Chronic Pain

Guest Blog Post by Gary Brothers, LCSW

When people think about EMDR, they often think about trauma and post-traumatic stress disorder (PTSD). Of course, EMDR is very effective in treating these, as well as many other conditions people suffer from, but most people don’t usually think about EMDR for chronic pain. I’ve been using EMDR to treat chronic pain for over 15 years, and it is extremely effective and so fascinating regarding how and why it works so well.

Tell us a little about yourself, your experience becoming an EMDR therapist, and how you became interested in chronic pain.

I first became interested in EMDR 22 years ago while living in Hawaii. I was primarily treating children and adolescents, and I didn’t know much about EMDR at the time as it was the first time it was offered in Hawaii. Back then, the basic training was divided into Level 1 and Level 2, but the EMDR trainer only came for Level 1. Something happened, and the Level 2 training was canceled and never rescheduled. So, my colleagues and I finished reading the training manual and tried to learn it the best we could.

A couple of years after I moved to Austin, Texas, in 2006, I saw this job posting to work for both a pain management company and a functional rehabilitation program. The position intrigued me, so I interviewed and liked the therapists working there. I took the position, and it was interesting as I split my time working at two companies with the same owners but two completely different models of care regarding how to treat pain. And I realized how many of the clients in pain were so similar to the kids I had always been working with but who just never got better. Sure, they had chronic pain and health conditions, but they also had all this unresolved trauma and other mental health struggles along with their pain issues.

I decided to get properly trained in EMDR, and that’s when I met a phenomenal trainer in Austin, Rick Levinson. That’s when I truly learned EMDR. Shortly after that, I attended Mark Grant’s training to learn his Pain Protocol, then Steven Marcus’ training to understand his Migraine Protocol, and so many other EMDR continuing education trainings for trauma, complex PTSD, depression, and so forth. Each training made me increasingly more curious about what was going on with my clients neurobiologically and how EMDR can help them to heal.

How can EMDR therapy help with chronic pain? What successes have you experienced when using EMDR therapy with chronic pain?

EMDR works in multiple ways to help with chronic pain and ideally the EMDR therapist would integrate the standard therapy protocol with the pain protocol and other resourcing strategies based on the AIP Model. In doing so, multiple changes occur throughout the body including disrupting the pain neural pathways and networks that reinforce the pain experience, disrupting and reprocessing other maladaptive memory networks that reinforce these pain neural pathways and networks, and restoring more healthy and adaptive biochemical states in the body and what is referred to as regional brain functioning. As this occurs, the different substructures of the brain are able to again work together with one another in pro-health states versus states of unhealth and amplified pain perception.

Through these processes, the nerves in the peripheral nervous system, or wherever that part of the body is hurting, can once again turn off rather than repetitiously and/or continuously be stuck in on. In short, EMDR therapy facilitates changes in the brain and throughout the nervous system with the goal of shifting the brain and body from being in chronic pain back to the way it used to be regarding how one experienced pain. These aren’t psychological shifts or changes but physiological.

Success varies among individuals and depends on several factors. Some people who have been almost completely nonfunctional due to pain can achieve very low levels and, at times, completely abated pain. Many people with severe chronic health conditions have been able to find more and more extended periods of remission with fewer and less severe flare-ups. Some people with more serious neurodegenerative disorders have been able to manage these much better and what appears even to slow down the progression of the degeneration of these conditions. While further research is still needed to establish a causal relationship between EMDR and improved outcomes for some of these health conditions, it has been established in the research with chronic pain (Tesarz, et al., 2014).

Are there cautionary measures you would like to mention regarding the use of EMDR therapy with chronic pain?

Effectively treating chronic pain most often involves the use of more than one protocol. As a consultant, therapists often ask me to explain Mark Grant’s EMDR Pain Protocol. The EMDR Pain Protocol works amazingly well. I was trained in it by Mark Grant years ago. I use it frequently and understand it well. However, chronic pain and chronic health conditions resulting in pain can be complicated, and treating these most effectively involves more than one protocol. It requires some understanding of the neurobiology of pain and how and why many health conditions develop due to trauma, especially attachment and developmental trauma. It also involves learning how to integrate the standard therapy protocol, more specialized protocols, and resourcing strategies. I believe learning about pain is just as important as learning the protocols to treat it. It’s the key to effectively using the protocols.

Are there any myths you’d like to bust about using EMDR therapy with chronic pain?

Treating chronic pain with EMDR is usually not a one-and-done treatment or intervention. Chronic pain develops due to maladaptive neuroplasticity, or the repetitious firing of the pain signals generally originating in the peripheral nervous system and then to and through the central nervous system. It is in the brain wheually experience pain. The area of the body where there is tissue damage or irritation is just sending a pain signal via the nerves which serve as a relay system to the brain where it is processed as pain. Over time there are changes both throughout the body and in the brain that are chemical, structural on a cellular level, and then systemic including how individual systems of the body work as well as how the body is functioning as a whole. While one EMDR session may provide great relief, and at times even abate the pain entirely, to undo the maladaptive neuroplastic changes that have occurred the EMDR therapist typically is going to need to facilitate repetitive corrective interventions for enduring systemic changes to persist.

What multicultural considerations might EMDR therapists need to keep in mind regarding EMDR therapy and clients coping with chronic pain?

Pain is filtered through the lens of one’s culture. How pain is experienced and how pain is expressed has many cultural implications to it. Be curious, open to, and aware of cultural factors that are not only part of the dynamic of the therapeutic process but also consider the client’s experience of pain and how that pain is expressed. Therapists also need to realize that pain is not just a matter of tissue input. It has a lot to do with our memory networks. Pain is an interface between what is being activated in the present in our somatosensory system and how we are primed for these experiences, which serves as a template for our somatosensory system (Tabor et al., 2017). A person’s culture has so much to do with this template. Our culture is deeply embedded in our memory networks. It is not the therapist’s role to interpret or to determine these implications but to explore with their clients because clients are the experts of their own culture. It is a collaborative partnership where the therapist provides information from a position of cultural humility so clients can navigate the therapeutic process with understanding and empowerment.

Do you have any favorite free EMDR-related resource that you would suggest to EMDR therapists working with this population?

My favorite website to teach people about chronic pain is Neuroplastix
The American Chronic Pain Association has many resources for people living with chronic pain and their families.
The International Association for the Study of Pain also has several resources for people living with chronic pain and their families.
As does U.S. Pain Foundation.
I also like the Flippin’ Pain website.
I offer complimentary auditory bilateral stimulation for people in pain here: BLS Drum Therapy.
You can also check out my educational videos on my YouTube channel here.

What would you like people outside the EMDR community to know about EMDR therapy and chronic pain?

Most people living with chronic pain can get much better with the proper treatment, and EMDR can be a very effective treatment for chronic pain. This is not to suggest that EMDR will repair all the structural damage or dysfunction in the body. However, chronic pain is a syndrome state in the body that primarily involves maladaptive changes that have occurred in the nervous system. As a result, the body also becomes biochemically out of balance in very unfortunate ways. I am not at all suggesting chronic pain is a psychological issue; it is a physical condition that involves how the body is functioning. It does have psychological implications, which is why we can call it psychophysiological, but at the core of chronic pain are the physiological changes that occur systemically in the body over time due to the ongoing firing of the pain signals. These can be treated and need to be treated at the nervous system level, which is what EMDR effectively treats.

Gary Brothers, LICSW has over 25 years of experience treating adults, teens, children, and families at all levels of care, from the counseling office, outpatient counseling programs, psychiatric hospitals, residential treatment programs, and in school settings. He specializes in treating trauma/PTSD, chronic pain, and chronic health conditions.

References

American Chronic Pain Association. https://www.acpanow.com

Brothers, G. BLS Drum Therapy. https://www.garybrotherscounseling.com/bls-drum-therapy.html

Brothers, G. YouTube channel. https://www.youtube.com/channel/UCOoAGGEnZDhoEDjExSTFCSA?app=desktop

Flippin’ Pain. https://www.flippinpain.co.uk/

International Association for the Study of Pain. Living with pain resources. https://www.iasp-pain.org/resources/living-with-pain/

Neuroplastix. Change the brain; relieve the pain; transform the person. http://neuroplastix.com/

Tabor, A., Thacker, M. A., Moseley, G. L., & Kording, K. P. (2017). Pain: A statistical account. PLOS Computational Biology, 13(1): e1005142. Open access: https://doi.org/10.1371/journal.pcbi.1005142

Tesarz, J., Leisner, S., Gerhardt, A., Janke, S., Seidler, G. H., Eich, W., & Hartmann, M. (2014). Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: A systematic review. Pain Medicine, 15(2), 247-263. Open access: https://doi.org/10.1111/pme.12303

U. S. Pain Foundation. https://uspainfoundation.org/

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