Ärztliche Psychotherapie

Vock, Stephanie; Seidler, Günter H.; Tesarz, Jonas

EMDR in der Behandlung chronischer Schmerzen

, 18. Jahrgang, Heft 3, pp 198-202

DOI 10.21706/aep-18-3-198

Zusammenfassung

Chronische Schmerzen können auch dann noch anhalten, wenn die zugrunde liegenden Ursachen behoben sind. Dadurch wird der Schmerz selbst zur Erkrankung und es kommt zu Veränderungen im Nervensystem, welcher wiederum den Schmerz aufrechterhält und Therapien erschwert. Emotionale Belastung, psychische Traumata und posttraumatische Stresssymptome begünstigen diese Prozesse. Klassische Ansätze der psychologischen Schmerztherapie stoßen oftmals an ihre Grenzen, wenn es darum geht, emotionale Belastungen, psychische Traumata und posttraumatischen Stress zu behandeln. Die Eye Movement Desensitization and Reprocessing (EMDR) Methode hingegen bearbeitet sowohl belastende Emotionen als auch Körperempfindungen und -erfahrungen und kann dadurch eine Reduktion des Schmerzes bewirken. Angesichts der hohen Komorbidität von chronischen Schmerzen, emotionaler Belastung und psychischen Traumata ist es verständlich, dass EMDR zunehmend in die psychologische Schmerztherapie integriert wird.

Abstract

EMDR in chronic pain treatment
Chronic pain can persist even after the underlying causes have been treated. As a result, the pain itself becomes a disease and changes occur in the nervous system, which in turn perpetuates the pain and makes therapies more difficult. Emotional distress, psychological trauma and post-traumatic stress symptoms facilitate these processes. Classical psychological approaches to pain often reach their limits when dealing with emotional distress, psychological trauma and post-traumatic stress. Eye Movement Desensitization and Reprocessing (EMDR), on the other hand, processes both distressing emotions and bodily sensations and experiences, and can lead to a reduction in pain. Given the high comorbidity of chronic pain, emotional distress and psychological trauma, it is understandable that EMDR is increasingly being integrated into psychological pain management.

Schlüsselwörter
Keywords
  1. Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V. & Cuneo, J. G. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med 76(1), 2–11. DOI 10.1097/PSY.0000000000000010.
  2. Baek, J., Lee, S., Cho, T., Kim, S. W., Kim, M., Yoon, Y., Kim, K. K., Byun, J., Kim, S. J., Jeong, J. & Shin, H. S. (2019). Neural circuits underlying a psychotherapeutic regimen for fear disorders. Nature 566(7744), 339–343. DOI 10.1038/s41586-019-0931-y.
  3. Buchbinder, R., van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M. & Croft, P. (2018). Low back pain: a call for action. Lancet 391(10137), 2384–2388. DOI 10.1016/S0140-6736(18)30488-4.
  4. Egloff, N., Hirschi, A. & von Känel, R. (2012). Schmerzstörungen bei Traumatisierten – neurophysiologische Aspekte und klinische Phänomenologie. Praxis 101(2), 87–97. Erratum in: Praxis 101(4), 214. DOI 10.1024/1661-8157/a000816.
  5. Fitzcharles, M. A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C. & Häuser W. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet 397(10289), 2098–2110. DOI 10.1016/S0140-6736(21)00392-5.
  6. GBD 2016. Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 (2017). Lancet 390(10100), 1211–1259.
  7. Gerhardt, A., Leisner, S., Hartmann, M., Janke, S., Seidler, G. H., Eich, W. & Tesarz, J. (2016). Eye movement desensitization and reprocessing vs. treatment-as-usual for non-specific chronic back pain patients with psychological trauma: A randomized controlled pilot study. Front Psychiatry 7(201), 1–10. DOI 10.3389/fpsyt.2016.00201.
  8. Grant, M. (2017). Pain Control with EMDR: Treatment manual 7th Revised Edition. Trauma and Pain Management Services Pty Ltd; Illustrated Edition.
  9. Hashmi, J., Baliki, M., Huang, L., Baria, A., Torbey, S., Hermann, K., Schnitzer, T. J. & Apkarian, A. (2013). Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain 136(9), 2751–2768. DOI 10.1093/brain/awt211.
  10. IASP (2012). Unrelieved pain is a major global health-care problem. Washington, DC.: International Association for the Study of Pain.
  11. Jauch, I., Kamm, J., Benn, L., Rettig, L., Friederich, H., Tesarz, J., Kuner & T. Wieland, S. (2023). 2MDR, a microcomputer-controlled visual stimulation device for psychotherapy--Like Treatments of Mice. ENEURO 10(6). DOI 10.1523/ENEURO.0394-22.2023.
  12. Maroufi, M., Zamani, S., Izadikhah, Z., Marofi, M. & O’Connor, P. (2016). Investigating the effect of Eye Movement Desensitization and Reprocessing (EMDR) on postoperative pain intensity in adolescents undergoing surgery: a randomized controlled trial. J Advanced Nursing 72(9), 2207–2217. DOI 10.1111/jan.12985.
  13. Nia, N. G., Afrasiabifar, A. & Behnammoghadam, M. (2018). Comparing the effect of eye movement desensitization and reprocessing (EMDR) with guided imagery on pain severity in patients with rheumatoid arthritis. J Pain Res 28(11), 2107–2113. DOI 10.2147/JPR.S158981.
  14. Rostaminejad, A., Behnammoghadam, M., Rostaminejad, M., Behnammoghadam, Z. & Bashti, S. (2017). Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. Int J Rehabil Res 40(3), 209–214. DOI 10.1097/MRR.0000000000000227.
  15. Schneider, J., Hofmann, A., Rost, C. & Shapiro, F. (2008). EMDR in the treatment of chronic phantom limb pain. Pain Med 9(1), 76–82. DOI 10.1111/j.1526-4637.2007.00299.x.
  16. Tesarz, J., Gerhardt, A., Leisner, S., Janke, S., Treede, RD. & Eich, W. (2015). Distinct quantitative sensory testing profiles in nonspecific chronic back pain subjects with and without psychological trauma. PAIN 156(4), 577–586. DOI 10.1097/01.j.pain.0000460350.30707.8d.
  17. Tesarz, J., Leisner, S., Gerhardt, A., Janke, S., Seidler, G., Eich, W. & Hartmann, M. (2014). Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: a systematic review. Pain Med 15(2), 247–263. DOI 10.1111/pme.12303.
  18. Tesarz, J. & Kuner, R. (2023). Schmerz ohne Ende: Auf dem Weg zur personalisierten Therapie. Ruperto Carola 21 (2023), 121–129.
  19. Tesarz, J., Seidler, G. H. & Eich, W. (2015). Treatment of pain with EMDR (in German). Stuttgart: Klett-Cotta.
  20. Tesarz, J., Seidler, G. & Eich, W. (2016). Chronische Schmerzstörungen: Einsatz von EMDR in der Schmerztherapie. PiD – Psychotherapie im Dialog 17(04), 10–11. DOI 10.1055/s-0042-116696.
  21. Tesarz, J., Seidler, G. H. & Eich, W. (2018). EMDR Therapy and Chronic Pain Conditions. Eye Movement Desensitization and Reprocessing (EMDR) Therapy Scripted Protocols and Summary Sheets: Treating Eating Disorders, Chronic Pain and Maladaptive Self-Care Behaviors, 273.
  22. Tesarz, J., Wolfgang, E., Treede, RD. & Gerhardt, A. (2016). Altered pressure pain thresholds and increased wind-up in adult chronic back pain patients with a history of childhood maltreatment: a quantitative sensory testing study. PAIN 157(8), 1799–1809. DOI 10.1097/j.pain.0000000000000586.
  23. Wilensky, M. (2006). Eye Movement Desensitization and Reprocessing (EMDR) as a Treatment for Phantom Limb Pain. J Brief Ther 5(1), 31–44.
  24. Williams, A. C. C., Fisher, E., Hearn, L. & Eccleston, C. (2020). Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 8(8), CD007407. DOI 10.1002/14651858.CD007407.pub4.