Treatment of chronic phantom limb pain using a trauma-focused psychological approach

BACkgRound: Chronic phantom limb pain (PLP) is a disabling
chronic pain syndrome for which regular pain treatment is seldom effective.
Pain memories resulting from long-lasting preamputation pain or pain
flashbacks, which are part of a traumatic memory, are reported to be powerful
elicitors of PLP.
oBJeCTiVe: To investigate whether a psychological treatment directed
at processing the emotional and somatosensory memories associated with
amputation reduces PLP.
MeTHodS: Ten consecutive participants (six men and four women)
with chronic PLP after leg amputation were treated with eye movement
desensitization and reprocessing (EMDR). Pain intensity was assessed during
a two-week period before and after treatment (mean number of sessions
= 5.9), and at short- (three months) and long-term (mean 2.8 years)
follow-up.
ReSuLTS: Multivariate ANOVA for repeated measures revealed an overall
time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison
showed a significant decrease in mean pain score before and after treatment
(P=0.00), which was maintained three months later. All but two
participants improved and four were considered to be completely pain free
at three months follow-up. Of the six participants available at long-term
follow-up (mean 2.8 years), three were pain free and two had reduced pain
intensity.
ConCLuSionS: These preliminary results suggest that, following a
psychological intervention focused on trauma or pain-related memories,
substantial long-term reduction of chronic PLP can be achieved. However,
larger outcome studies are required.