Video 017 Pain protocol for chronic pain (Revised)

Use this solution

When client suffering chronic pain.  This is pain that may or may not show a clear link to a cause, medical or otherwise in the here and now.  Note, if there is unresolved trauma with links to the pain, desensitize and reprocess the trauma first, then target the pain.

Originator:

Mark Grant (2002) based on the work of Francine Shapiro and developed by Carlijn de Roos and Sandra Veenstra, (2007)

Video production

Matthew Davies Media Ltd, Llanidloes, Powys. www.matthewmedia.com

Take-Away Section

What this covers

The video of the case shows Carla, who is experiencing chronic pain with no evident cause in the here and now, and there is no history of trauma. The introduction is new and is based on the latest research on the creation of pain, it’s purpose and what as therapists we are actually doing when we use EMDR or sensori-motor interventions, i.e. the mechanism of change. It also stresses the vital importance of the therapist/client rapport.

The therapist in the video helps Carla to describe the pain both verbally and using a drawing. The pain becomes the target image. The therapist helps the client identify a negative cognition and the body location of the pain.  BLS is used to lower the Subjective Units of Pain to zero. The video then shows the installation of the positive cognition and completion of the protocol with a body scan.

How long

12.42 minutes

Related videos

Video 078(PT 1.4) NAW

Go to ‘Take-away’?

See Aide memoire for step by step guide for using this protocol. Also see News/Blog for March 2022 for latest understanding of pain, the importance of the therapeutic relationship, and evidence for using EMDR.

+ Aide Mémoire

You can copy and paste this material into a Word document, edit it, and add other information you think may be helpful to you.

The pain protocol has 6 tasks

1. Build a strong rapport with the client and provide a clear explanation of the process.
2. Insure pain is within tolerable levels of severity.
3. Review medical diagnosis and patient’s attitude to the diagnosis.
4. Identify and prioritize the pain targets for reprocessing.
5. Facilitate relaxation and change in pain sensations.
6. Develop psychological pain-management resources.

The first task is critical to the overall process as shown in the diagram below:

https://drive.google.com/file/d/1tFy3iOpviuCat0rH-VVfzZJj1BwwtKcT/view?usp=sharing

The next two tasks are designed to ensure medical aspects of treatment are adequate and have been done before the tasks 4-6.

• Pain assessment. Take a subjective measure of pain (0-10 scale) and get the client’s attitude to his or her pain. Make sure the pain is being adequately managed. Client with extreme pain and with significant emotional distress are less likely to be able to adequately focus and concentrate on the elements of the standard protocol required of them. In such cases you may need to refer them back to a Doctor for treatment.
• Review of diagnosis. Take a comprehensive history of previous medical investigation and treatments including the existence or not of a medical diagnosis and the psychological effects of medical treatment. The existence of a diagnosis is said to be a strong predictor of recovery. On the other hand, clients who are anxious because their diagnosis is unclear or uncertain may have limited motivation for psychological treatment. These issues may need addressing prior to tasks 3-5

Tasks 4-6 are shown in the video. They involve facilitating changes in pain sensations and developing new coping strategies.

• Ask the client to describe the pain in words using an image or metaphor
• Ask the client to draw an image of their pain
• The client looks at the drawn image of their pain and identifies the negative cognition(s) associated with the pain. (If there are several significant NC's, plan to process each one in turn with an appropriate PC)
• Ask for a score of Subjective Units of Pain (SUPs) on a scale of 0-10.
• Identify the positive cognition by asking ‘What would you prefer to think about yourself now?
• Identify the VoC for the positive cognition and assess on a scale of 1-7.
• Ask the client for a body location of the pain.
• Use bilateral stimulation (BLS) in the normal way until the SUPs are reduced to 0 or 1.
• Check the positive cognition is still relevant
• Install the positive cognition to a VoC of 7
• Complete the protocol with a body scan holding the positive cognition with the original image of the pain
• If there is any tension or disturbance, use BLS to reduce it.
• Identify the most positive thing the client has learned about pain during the session. Install that as a pain-management resource.
• Make sure the client knows that EMDR continues to work after the session. Sometimes clients experience a temporary increase in pain levels. Ask the client to notice any changes and use them in the next session either to process or as a resource to install.
  Note: If the client reports another surge of pain sometime after this process, inquire into the circumtances. It may be that an event has triggered a memory connected to the pain's original onset. Treat this as you would any trigger and desnsitize and reprocess it as belonnging to the second prong of the three prong EMDR process. Also consider what you need to do as the third prong - the future - especially if the client is expresssing anxiety about whether the pain may return. Consider using Flash forward (See Video 007).

+ Wrap-Up