title: Effects of eye movement desensitization and reprocessing (EMDR) on non-specific chronic back pain: a randomized controlled trial with additional exploration of the underlying mechanisms.
abstract: BACKGROUND
  Non-specific chronic back pain (CBP) is often accompanied by psychological trauma, but treatment for this associated condition is often insufficient.Nevertheless, despite the common co-occurrence of pain and psychological trauma, a specific trauma-focused approach for treating CBP has been neglected to date. Accordingly, eye movement desensitization and reprocessing (EMDR), originally developed as a treatment approach for posttraumatic stress disorders, is a promising approach for treating CBP in patients who have experienced psychological trauma.Thus, the aim of this study is to determine whether a standardized, short-term EMDR intervention added to treatment as usual (TAU) reduces pain intensity in CBP patients with psychological trauma vs. TAU alone.
  
  
  METHODS
  The study will recruit 40 non-specific CBP patients who have experienced psychological trauma. After a baseline assessment, the patients will be randomized to either an intervention group (n = 20) or a control group (n = 20). Individuals in the EMDR group will receive ten 90-minute sessions of EMDR fortnightly in addition to TAU. The control group will receive TAU alone. The post-treatment assessments will take place two weeks after the last EMDR session and six months later.The primary outcome will be the change in the intensity of CBP within the last four weeks (numeric rating scale 0-10) from the pre-treatment assessment to the post-treatment assessment two weeks after the completion of treatment.In addition, the patients will undergo a thorough assessment of the change in the experience of pain, disability, trauma-associated distress, mental co-morbidities, resilience, and quality of life to explore distinct treatment effects. To explore the mechanisms of action that are involved, changes in pain perception and pain processing (quantitative sensory testing, conditioned pain modulation) will also be assessed.The statistical analysis of the primary outcome will be performed on an intention-to-treat basis. The secondary outcomes will be analyzed in an explorative, descriptive manner.
  
  
  CONCLUSIONS
  This study adapts the standard EMDR treatment for traumatized patients to patients with CBP who have experienced psychological trauma. This specific, mechanism-based approach might benefit patients.
  
  
  BACKGROUND
  This trial has been registered with ClinicalTrials.gov (NCT01850875).
authors.affiliation: Department of Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg D-69120, Germany. jonas.tesarz@med.uni-heidelberg.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Tesarz
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerhardt
authors.forename: Sabine
authors.initials: S
authors.lastname: Leisner
authors.forename: Susanne
authors.initials: S
authors.lastname: Janke
authors.forename: Mechthild
authors.initials: M
authors.lastname: Hartmann
authors.forename: Günther H
authors.initials: GH
authors.lastname: Seidler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eich
mesh_terms: D001416:Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004185:Disability Evaluation; D057169:Eye Movement Desensitization Reprocessing; D005858:Germany; D006801:Humans; D010147:Pain Measurement; D011788:Quality of Life; D012107:Research Design; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome