title: Treatment of chronic phantom limb pain using a trauma-focused psychological approach.
abstract: 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.
authors.affiliation: Mental Health Center Rivierduinen, Leiden, The Netherlands. c.deroos@ggzkinderenenjeugd.nl
authors.forename: Carlijn
authors.initials: C
authors.lastname: de Roos
authors.forename: A C
authors.initials: AC
authors.lastname: Veenstra
authors.forename: A
authors.initials: A
authors.lastname: de Jongh
authors.forename: M
authors.initials: M
authors.lastname: den Hollander-Gijsman
authors.forename: N J A
authors.initials: NJ
authors.lastname: van der Wee
authors.forename: F G
authors.initials: FG
authors.lastname: Zitman
authors.forename: Y R
authors.initials: YR
authors.lastname: van Rood
mesh_terms: 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
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