When people come to see me with #Chroniclowerbackpain, I offer a combination of #Pilates and #EMDR (Eye Movement Desensitisation & Reprocessing), a therapy for the treatment of #trauma and for #Chronicpain. In my last blog, I looked at the research evidence supporting the use of Pilates for the treatment of #Backpain and today I'll be looking at the evidence for EMDR:
In 2019, a team led by Jonas Tersarz, published a review of six Randomised Control Trials (RCTs) examining the effectiveness of EMDR for the treatment of chronic pain (Tersarz et al. 2019. Journal of EMDR Practice & Research) and found that the "studies consistently showed a significant improvement in pain intensity, with overall high effect sizes, following EMDR interventions." The RCTs included follow-up studies, where participants were reviewed again six months later and found that the initial improvements had been maintained and in some cases, participants' pain had improved even further.
Like all good the researchers, the group are cautious not to oversell the results and note alternative explanations for the improvements, such as "increased attention from healthcare professionals" or "distraction and relaxation" techniques. Methodological limitations between studies may also have had an impact on the results, but they do conclude the RCTs included in the review provide "....preliminary evidence that EMDR appears to be sustainably effective" in treating chronic pain.
One the RCTs (Gerhardt et al 2016. Eye movement desensitization and reprocessing vs. treatment-as-usual for non-specific chronic back pain patients with psychological trauma: A randomized controlled pilot study. Frontiers in Psychiatry, 7(201), 1–10. ), looked specifically at the effectiveness of EMDR in treating people with chronic, non-specific lower back pain, who also have histories of psychological trauma. The study involved forty people presenting with these two conditions, who were randomly allocated to either an intervention group or a "treatment-as-usual" (TAU). TAU involved advice and education, physiotherapy and, where appropriate, medication. The intervention group received ten, ninety-minute, fortnightly sessions of EMDR, a combination of the Standard Protocol (the original EMDR protocol, designed for the treatment of trauma and protocols designed for the treatment of chronic pain. EMDR was used to process: disturbing memories associated with pain; current perceptions of pain; anticipated future painful experiences and associated cognitions, emotions and bodily sensations.
Researchers used the following measures to assess the progress of participants in both groups:
Pain intensity
Disability (the extent to which pain interferes with the participants' daily life)
Participants' perceptions of change
Change in the overall situation
The results showed that 50% of the intervention group improved to a "clinically relevant" (significant) extent, compared to 0% in the control (TAU).
The study concludes that EMDR "significantly" reduced pain intensity and disability post-treatment and at six month follow-up. This study is particularly significant for me as I work with with people who have psychological trauma as well as chronic lower back pain and where the two are connected.
So, there is a growing number of studies showing the beneficial impact of EMDR on chronic pain, including chronic lower back pain, as well as evidence that Pilates can help reduce lower back pain. This evidence is important and underlies the design of the combined programme of Pilates and EMDR which I offer to people with chronic lower back pain: if you're living with this condition, you know how much it impacts on your life. You may have tried lots of different treatments over the years and felt the repeated frustrations of realising the treatment wasn't helping or the effect didn't last very long. This is why I offer a programme with solid evidence behind it, to try to make the service as helpful as possible.
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