How EMDR Therapy Helps Manage Chronic Pain

Chronic pain is a widespread and often life-altering condition that affects both the body and the mind. In recent years, researchers and clinicians have discovered that trauma and chronic pain are deeply connected. People with chronic pain are much more likely to also experience post-traumatic stress disorder (PTSD), and vice versa. This article explores how Eye Movement Desensitization and Reprocessing (EMDR) therapy—a treatment originally developed for trauma— can help manage chronic pain in sufferers. We’ll break down the science, the protocol, and practical tips, all in straightforward language.

The Hidden Link Between Pain and Trauma

Pain isn’t just a physical sensation. According to the International Association for the Study of Pain (IASP, 2020), pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” This definition highlights how pain is both a body and a mind experience.

Many people with chronic pain also have a history of trauma. Studies show that those with chronic pain are up to four times more likely to have PTSD (Siqveland et al., 2017). Trauma doesn’t always mean a single, dramatic event—it can also include childhood neglect, difficult relationships, or ongoing stress. These experiences can change the way our brains process pain, making it more likely that pain will become chronic and hard to treat (Herman, 2022).

Chronic pain and trauma both involve changes in memory and the nervous system. When pain or trauma is repeated, it can create lasting changes in the brain—a process called “central sensitization.” This means the body becomes more sensitive to pain signals, even after the original injury has healed.

Why Use EMDR for Chronic Pain?

EMDR therapy was first developed to help people recover from traumatic memories. However, because chronic pain and trauma are so closely linked, EMDR has been adapted to help people manage persistent pain as well.

The science behind EMDR for pain is based on the Adaptive Information Processing (AIP) model. This model suggests that our brains are naturally wired to heal from difficult experiences, but sometimes memories or pain sensations get “stuck.” EMDR uses specific techniques to help the brain process and release these stuck experiences, reducing both emotional and physical symptoms (Shapiro, 2018).

Research shows that EMDR can help with many types of chronic pain, including back pain, phantom limb pain, fibromyalgia, headaches, and even pain related to conditions like endometriosis and multiple sclerosis (Tesarz et al., 2014; Gerhardt et al., 2016). People who receive EMDR often report less pain, better mood, and a higher quality of life.

The EMDR Pain Protocol: Step-by-Step

The EMDR protocol for pain follows a structured process, with some key differences from the standard trauma protocol. Here’s how it works:

1. Explaining Chronic Pain and EMDR

The therapist starts by explaining how chronic pain can get “locked” in the nervous system due to changes in the brain and body. They introduce EMDR as a way to help the nervous system heal, even if it doesn’t completely eliminate pain. Clients are encouraged to notice their sensations without judgment and to keep an open mind.

2. Target Setup: Finding the Focus

The therapist helps the client identify a “target” for reprocessing. For pain, this usually means:

• The most distressing image or sensation linked to the pain

• The negative belief about oneself that comes with the pain (like “I’m broken”)

• How strongly the client believes this negative thought (rated 1-7)

• The main emotion connected to the pain, and its intensity (rated 1-10)

• Where the pain is felt in the body

For chronic pain, the focus is often on the present sensation and the feelings it brings up.

3. Desensitization: Processing the Pain

This is the core of EMDR. The therapist uses bilateral stimulation (BLS)—like eye movements, tapping, or sounds—to help the client process the pain and related memories. The client focuses on the pain image, the negative belief, and the physical sensation while BLS is happening.

After each set, the therapist checks in about any new thoughts, feelings, or body sensations. This back-and-forth helps the therapist adjust the process and track progress. The goal is to reduce the distress linked to the pain, ideally to a 0 on a 1-10 scale. Even if pain doesn’t disappear, it often becomes less overwhelming, giving clients a greater sense of control.

4. Installation: Building Positive Change

Once the distress is reduced, the therapist helps the client strengthen any positive beliefs or feelings that have emerged. This might include:

• Asking what the client would like to believe about themselves now (e.g., “I am resilient”)

• Identifying an image or metaphor that represents relief (like a shrinking dark cloud or a warm blanket)

• Using BLS to “install” this positive association

This step helps the brain connect relief and hope to the pain experience, making it easier to recall these positive feelings in the future.

5. Body Scan: Checking for Leftover Distress

The therapist guides the client to mentally scan their body from head to toe, looking for any remaining discomfort or tension. If any is found, more BLS can be used to process these sensations. This step ensures that the positive changes are felt physically, not just mentally.

6. Closure: Ending the Session Safely

Whether or not all pain or distress is resolved, closure is about helping the client feel stable and safe at the end of the session. The therapist:

• Reassures the client that changes from EMDR can last and often grow over time

• Encourages the client to stay present and notice their feelings without judgment

• Provides resources for self-care, such as audio BLS or visualization exercises

• Reminds the client to seek medical help if pain becomes unmanageable

Closure ensures clients leave feeling calm and empowered, with tools to manage pain between sessions.

7. Re-evaluation: Tracking Progress

At the start of each new session, the therapist checks in on changes in pain, mood, sleep, and daily activities. Even small improvements are important. The therapist also looks for new issues or targets for future EMDR work.

Key Differences in the EMDR Pain Protocol

Chronic pain is complex, so the EMDR pain protocol includes some special adaptations:

Targeting Sensory Distress Directly

Instead of focusing only on past traumatic memories, EMDR for pain often targets the current sensory experience. Clients may be asked to describe their pain using colors, shapes, or even drawings. This makes the pain more concrete and easier to process.

Continuous Bilateral Stimulation

For chronic pain, therapists may use continuous BLS instead of short sets. This helps maintain focus and can be especially helpful for people whose pain feels constant or who have trouble staying present.

Focusing on Sensations as Well as Emotions

While emotions are always part of pain, the protocol puts extra emphasis on how pain feels in the body and what it means to the client. This helps create a more personal and effective target for EMDR.

Flexible Use of Positive Cognition

Some clients with long-term pain struggle to believe positive thoughts at first. The protocol allows therapists to introduce positive beliefs later in the process, after some relief has been felt.

Stronger Somatic (Body-Focused) Resources

Because pain is so physical, the protocol includes more body-focused coping tools. These might include:

• Imagining pain-relieving images (like a healing light)

• Remembering times of comfort or well-being

• Using distraction techniques

Therapists help clients notice and reinforce even small positive changes.

Self-Use of BLS

For some clients, using audio BLS at home can be a helpful way to manage pain, stress, or insomnia between sessions. However, this is only recommended after clients have experienced positive effects with their therapist.

Integration with Other Treatments

EMDR is often just one part of a larger pain management plan. It can be combined with medical care, physical therapy, medication, and other psychological approaches.

Practical Tips for Clients Considering EMDR for Pain

If you’re thinking about trying EMDR for chronic pain, here are some tips to get the most out of it:

• Keep an Open Mind: EMDR can feel strange at first, but being open to the process helps your brain respond.

• Describe Your Pain Clearly: Use words, images, or drawings to help your therapist understand what you’re feeling.

• Notice Small Changes: Even if your pain isn’t gone, pay attention to any reduction in intensity or changes in how you feel about it.

• Practice Self-Care: Use the tools your therapist gives you between sessions to build on your progress.

• Communicate Honestly: Let your therapist know what’s working and what isn’t, both during and after sessions.

The Science Behind EMDR and Chronic Pain

Research supports the use of EMDR for chronic pain. Studies have found that EMDR can reduce pain intensity, improve mood, and enhance quality of life for people with conditions like fibromyalgia, migraines, and phantom limb pain (Tesarz et al., 2014; Gerhardt et al., 2016).

The reason EMDR works is that both trauma and pain are processed in similar parts of the brain. By helping the brain “reprocess” stuck pain signals, EMDR can help unlock pain that has become chronic (Grant & Threlfo, 2002; Shapiro, 2018).

Final Notes: How EMDR Therapy Helps Manage Chronic Pain

Chronic pain can feel overwhelming, but there is hope. EMDR therapy offers a structured, evidence-based way to reduce pain, shift unhelpful beliefs, and regain control. By combining desensitization, positive reinforcement, body awareness, and practical resources, EMDR helps people move from suffering to empowerment.

If you or someone you know is struggling with chronic pain, consider talking to a qualified EMDR therapist. Remember, EMDR is most effective as part of a comprehensive pain management plan, and it’s important to consult with healthcare professionals before making changes to your treatment.

References

• Gerhardt, A., et al. (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. Frontiers in Psychiatry, 7(201). https://doi.org/10.3389/fpsyt.2016.00201

• Grant, M., & Threlfo, C. (2002). EMDR in the treatment of chronic pain. Journal of clinical psychology, 58(12), 1505–1520. https://doi.org/10.1002/jclp.10101

• Herman, J. L. (2022). Truth and repair: How trauma survivors envision justice. Basic Books.

• International Association for the Study of Pain. (2020). IASP terminology. https://www.iasp-pain.org/resources/terminology/

• Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.

• Siqveland, J., et al. (2017). Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis. Frontiers in Psychiatry, 8(164). https://doi.org/10.3389/fpsyt.2017.00164

• Tesarz, J., et al. (2019). EMDR therapy’s efficacy in the treatment of pain. Journal of EMDR Practice and Research, 13(4), 337–344. https://doi.org/10.1891/1933-3196.13.4.337