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.
de Roos
Carlijn
C
Mental Health Center Rivierduinen, Leiden, The Netherlands. c.deroos@ggzkinderenenjeugd.nl
Veenstra
A C
AC
de Jongh
A
A
den Hollander-Gijsman
M
M
van der Wee
N J A
NJ
Zitman
F G
FG
van Rood
Y R
YR
D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000523:psychology*; D001521:Behavior Therapy / Q000379:methods*; D057189:Checklist / Q000379:methods; D002908:Chronic Disease; D057169:Eye Movement Desensitization Reprocessing; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D010591:Phantom Limb / Q000150:complications* / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
Pain. 1990 Dec;43(3):319-336
2293143
Br J Psychiatry. 2007 Feb;190:97-104
17267924
Percept Mot Skills. 2002 Jun;94(3 Pt 1):996-1008
12081304
J Rehabil Res Dev. 2003 Jan-Feb;40(1):59-65
15150721
EMBO Rep. 2002 Apr;3(4):288-91
11943751
Neurocase. 2001;7(3):255-60
11459920
Clin J Pain. 2002 Mar-Apr;18(2):84-92
11882771
Brain. 2001 Nov;124(Pt 11):2268-77
11673327
Disabil Rehabil. 2004 Jul 22-Aug 5;26(14-15):837-50
15497913
J Neurosci. 1997 Jul 15;17(14):5503-8
9204932
Nat Rev Neurosci. 2006 Nov;7(11):873-81
17053811
Psychother Psychosom. 2006;75(5):290-7
16899965
Pain. 2000 Jul;87(1):33-41
10863043
Lancet. 2001 Jun 2;357(9270):1763-4
11403816
Nat Neurosci. 1999 Jun;2(6):501-2
10448212
Pain. 1985 Mar;21(3):267-278
3991231
Curr Rev Pain. 2000;4(2):166-70
10998730
J Cogn Neurosci. 1999 Sep;11(5):491-501
10511638
Ann Neurol. 2000 Dec;48(6):842-9
11117540
Nature. 1995 Oct 12;377(6549):489-90
7566144
J Clin Epidemiol. 1998 Nov;51(11):1055-68
9817123
Clin J Pain. 2004 Mar-Apr;20(2):83-7
14770047
Pain. 1993 Jul;54(1):107-110
8378097
J Dent Educ. 2001 Dec;65(12):1378-82
11780656
Pain Med. 2008 Jan-Feb;9(1):76-82
18254770
Psychol Assess. 2004 Mar;16(1):16-26
15023089
Br J Anaesth. 2001 Jul;87(1):107-16
11460799
Pain. 2007 Dec 5;132(3):332-336
17910905
Clin Rehabil. 2002 Jun;16(4):368-77
12061470
J Rehabil Med. 2003 May;(41 Suppl):66-72
12817660
Pain. 2001 Feb 1;90(1-2):47-55
11166969
Acupunct Med. 2004 Jun;22(2):93-7
15253586
Appl Psychophysiol Biofeedback. 2002 Sep;27(3):215-27
12206052
Nature. 1995 Jun 8;375(6531):482-4
7777055
Lancet Neurol. 2002 Jul;1(3):182-9
12849487