Treatment of Chronic Phantom Limb Pain Using a Trauma-Focused Psychological Approach

de Roos C., Veenstra, A.C., de Jongh A., den Hollander-Gijsman M.E., van der Wee N.J.A., Zitman, F. G., & van Rood Y.R. (2010). Treatment of chronic phantom limb pain using a trauma-focused psychological approach. Pain and Research Management: The Journal of the Canadian Pain Society, 15(2), 65-71. http://www.pulsus.com/journals/journalHome.jsp?origPg=journalHome.jsp&jnlKy=7&/home.htm&&HCtype=Consumer

In chapter 11 of our textbook, there is a research focus topic on phantom limbs. This whole phenomenon fascinates me, so I researched articles and found this one by several collaborating researchers. The overall hypothesis, or goal, was researching "the effectiveness of a trauma-focused psychological approach in the treatment of chronic phantom limb pain (PLP), using a standardized eye movement desensitization and reprocessing (EMDR) pain protocol." Since EMDR is used to rid trauma related memories, this technique was applied to PLP to either reduce or erradicate the memory-related pain in the phantom limb.
Participants ranged from age 32 to 67. There were ten participants in all, six males and four females. They all were assessed for chronic PLP before research began. The operational definition of PLP is reporting aching, squeezing, cramping, shooting, burning, stinging, or stabbing sensations. An average pain intensity was measured and recorded over a two week period and a long-term follow up.
A pretest/posttest design was utilized and data was collected two weeks prior to treatment and at two weeks, 3 months, and long-term subsequent to the treatment. Paricipants also kept a pain diary where they recorded pain as 0, feeling no pain, to 10, feeling the worst possible pain.
There were several different measures used during the treatment process: the Dutch version of the Symptom Checklist 90 (SCL-90) to determine psychological distress; the Checklist Individual Strength-Revised (CIS-20R) to measure fatique; the Dutch version of Impact of Events Scale and the Self-Inventory List to measure intensity of PTSD symptoms; and the Dutch version of the Short Form-36 Health Survey (SF-36) to measure the overall qualtiy of life due to health.
The treatment of EMDR involved eight stages involving bringing up the pain related distressing image and reassociating it with a positive image, while performing bilateral stimulation, which is moving the eyes quickly from left to right. This desensitization of the bad memory was repeated until the memory no longer existed, or was associated with the pain. The treatment ended when the patient noted a diminished or non-existent pain in the phantom limb.
The results were analyzed using a one-sample t-test in SPSS.
This study revealed treating bad memories through EMDR may relieve symptoms of PLP in some people. At the end of the three month period, four participants reported no pain and eight said their pain had diminished. Overall, the researchers concluded, "Cortical reorganization can be altered by changing the sensory input in the neural network either by strengthening it or taking it away."
Overall, the re-association technique seemed to be affective in treating those ten participants. They had to desensitize that area in the brain that reproduced the non-existent limb, so that the participants no longer felt pain.