Eye Movement Desensitization and Reprocessing for Chronic Pain: A Systematic Review

Abstract

Background:

Nonpharmacologic interventions have known benefits for managing chronic pain, particularly for conditions such as fibromyalgia, and are included in clinical guidelines. However, eye movement desensitization and reprocessing (EMDR) has not been established as a routine clinical practice for pain management.

Objective:

To systematically review the efficacy of EMDR for managing chronic pain.

Methods:

A search was conducted to identify randomized clinical trials (RCTs) and observational studies by using the keywords “EMDR” and “chronic pain.” Information was collected on the study population, EMDR protocol, methods for pain assessment, and outcomes. Risk of bias was evaluated, and intervention effect sizes were determined by calculating Hedges g values for long-term follow-up data in RCTs.

Results:

A total of nine studies, including seven RCTs, were reviewed. The studies used various diverse pain measurement tools and EMDR protocols. All reported significant improvements in pain symptoms with EMDR. Most of the studies reported statistically significant improvements in associated mental health issues, notably in psychological distress (four out of four studies), anxiety (three out of three studies), and depression (three out of four studies). Effect sizes varied among the studies, with three RCTs reporting large effects, two RCTs reporting moderate effects, and one RCT reporting small or nonsignificant effects.

Conclusion:

EMDR shows promise for managing chronic pain and addressing associated mental health symptoms. Despite study differences and limitations, the findings of this systematic review support the potential use of EMDR for chronic pain management.

Keywords

anxiety chronic pain depression eye movement desensitization reprocessing mental health pain management

Introduction

Chronic pain is a debilitating medical condition that affects people all around the world. Regardless of the cause, chronic pain may considerably reduce quality of life. Approximately 20% of US adults have had chronic pain at some point in their lives, ultimately leading to greater than $500 million in health care costs.^1,2 Whether localized or diffuse, the duration and severity of chronic pain are deeply intertwined with past experiences, often influenced by psychological factors. Patients with chronic pain retain a memory of the effects of it long after the causative agent is gone.³ Traditional medication approaches are often ineffective for managing chronic pain conditions such as fibromyalgia, necessitating a combined approach of pharmacologic and nonpharmacologic methods.⁴

Cognitive behavioral therapy and mindfulness are the most widely studied psychological interventions for managing chronic pain and appear to have positive effects on various outcomes. A 2020 Cochrane Review summarized the use of various psychotherapies for the management of chronic pain in adults.⁵ In 23 reviewed studies, cognitive behavioral therapy was reported as having a marginal benefit for managing pain versus the standard treatment regimen. Alternative nonpharmacologic therapies (e.g., guided imagery, hypnotherapy, and other methods) have had reportedly positive outcomes.⁶ Eye movement desensitization and reprocessing (EMDR) is one such alternative therapy that has emerged as a promising option.

EMDR, developed by Francine Shapiro in the 1980s,⁷ is a targeted form of psychotherapy that was first used to alleviate symptoms of post-traumatic stress disorder (PTSD). EMDR was built on the adaptive information processing model, which posits that previous traumatic events may contribute to current pathological processes, including somatic symptoms such as pain. By reprocessing traumatic memories, EMDR may help alleviate somatic symptoms by resolving underlying stressors.⁸ EMDR is administered in 1- to 1.5-h sessions for a total of 6 to 12 h during a period of 1 to 2 months. The structured format includes an 8-stage process, including (1) assessment of patient history, (2) patient preparation, (3) evaluation of the main aspects of the traumatic memory, (4) desensitization of the memory with bilateral rhythmic stimulation, (5) installation of the positive cognition, (6) body scan, (7) closure, and (8) reevaluation.⁹ Treatment response is assessed with the Validity of Cognition and Subjective Units of Disturbance scales. The efficacy of EMDR for the treatment of PTSD has been reported in several systematic reviews and meta-analyses, leading to its adoption in clinical practice guidelines for the management of PTSD and other mental health conditions.^7,9–11

Although EMDR has been primarily used for treating PTSD, EMDR may be effective for managing chronic pain conditions.^10,11 Indeed, previous systematic reviews have suggested that EMDR has efficacy for chronic pain.^12,13 However, research on this topic is still developing, and a more contemporary and comprehensive assessment of EMDR efficacy is needed.^14,15 To this end, this review systematically compiled and analyzed the latest research findings to assess whether EMDR is an effective approach to alleviate symptoms for patients with chronic pain conditions. Additionally, the benefits of EMDR for alleviating other mental health conditions concurrent with chronic pain were assessed. The findings of this review will shed light on the therapeutic benefits of EMDR for managing chronic pain as a nonpharmacologic therapy, particularly in the context of such conditions as phantom limb pain.

Materials and Methods

This systematic review was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines for search procedures, study selection, data collection, and analysis.¹⁶ The protocol was registered with the PROSPERO database (CRD #42023483455).

Data sources and searches

Five databases—Embase, Evidence-Based Medicine Reviews-Cochrane, PubMed, Scopus, and Web of Science—were used to identify published studies evaluating EMDR for the treatment of chronic pain in adults. All case-control studies, cohort studies, observational studies, randomized clinical trials (RCTs), and case series published were included. Searches were performed twice, once on September 1, 2023, and again on February 14, 2025. Articles published before January 1, 2013, were excluded. This time period was chosen because a previous comprehensive review by Tesarz et al.¹² included studies published from 1966 to 2013. The search strategy, including search terms, used in the current review for all databases is shown in the Supplementary Data. Two researchers (P.F. and Z.A.) independently screened articles for eligibility. Discrepancies were resolved by a discussion with other study investigators.

Studies were included if they met the following inclusion criteria: adult patients (≥18 years), EMDR as the intervention, English language, and pain as a measured outcome. Exclusion criteria included abstracts, editorials, comments, reviews, or guidelines; studies including children (<18 years); language other than English; and EMDR in combination with another intervention.

Data collection and risk of bias assessment

A data abstraction sheet was created, which included study design, sample size, country, study population, instruments used for pain measurement, and preintervention and postintervention measures. Two independent authors (P.F. and Z.A.) reviewed the full-text articles, performed the data abstraction, and assessed the risk of bias. The following data were abstracted: study identifier, publication date, recruitment period, study location, study design, baseline characteristics of participants (number of participants, age, and sex), treatment regimen, outcome measurement, and treatment outcome.

To rate the risk of bias, the Cochrane Risk of Bias 2 (RoB 2) tool was used to assess the risk of bias in RCTs,¹⁶ and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool was used to assess nonrandomized studies.¹⁷ RoB 2 evaluates five major domains of bias, which include the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. The ROBINS-I tool evaluates seven domains of bias: confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of the outcome, and selection of the reported result. The overall risk of bias for each study was determined according to these domains. The risk of bias was categorized as low, moderate, serious, or critical. Articles with insufficient data to ascertain the overall risk of bias were categorized as no information. Two authors (P.F. and Z.A.) evaluated the risk of bias independently, and disagreements were resolved through discussion with other study investigators.

Statistical analysis

The treatment effect sizes of the decrease in pain were estimated for the RCTs. To analyze treatment effects, standardized mean differences were used, including mean, standard deviation (SD), and sample size. For RCTs, standardized mean differences were evaluated with Hedges g values by using post-treatment data from the comparison groups, with positive Hedges g values indicating a preference for the EMDR intervention. Hedges g values less than 0.5 indicate a small effect size; from 0.5 to 0.8, a moderate effect size; and greater than 0.8, a large effect size. For observational studies, effect sizes were determined according to the means and pooled SDs of pre-treatment versus post-treatment data, providing assessments of the relative magnitudes of the treatment effects. Statistical analysis was conducted with BlueSky Statistics software, v7.40 (BlueSky Statistics).

Results

The initial search strategy identified 427 records of studies investigating EMDR treatment of chronic pain (Fig. 1). After removal of duplicates and other records meeting the exclusion criteria, 23 full-text articles were assessed, and 9 studies were included in the final analysis. These studies reported data for 410 participants, of whom 226 underwent EMDR for chronic pain.

FIG. 1.

Flow diagram of article selection process. EMDR indicates eye movement desensitization and reprocessing.

Study characteristics

Of the nine articles included in the analysis, seven were RCTs,^{14,15,18–22} one was a case-control study,²³ and one was a prospective observational trial²⁴ (Tables 1 and 2). The mean (SD) patient age was 48.07 (9.18) years. Among the studies that provided information on participant sex (eight out of nine studies),^{14,15,18–21,23} most participants were women, accounting for 254 of 398 participants (63.8%).

Table 1.

Characteristics of the Included Studies

Article	Country	Study design	Chronic pain condition (total participants)	Mean (SD) participant age, year	Participant sex: No.	Control group	Therapy/intervention	Therapist experience
Gerhardt et al.,¹⁸ 2016	Germany	RCT	Nonspecific chronic back pain and previous exposure to ≥1 psychologically traumatic event (n = 40)	56.6 (8.0)	Male: 12 Female: 28	Treatment as usual	10 biweekly 90-min EMDR sessions	Supervision by an EMDR-approved consultant and manual training for 3 days
Sinici²⁴ 2016	Turkey	Observational	Phantom limb pain (n = 14)	30.53 (14.95)	NR	Pre-treatment	3–6 EMDR sessions of unspecified duration	NR
Benor et al.,¹⁹ 2017	Canada	Crossover RCT	Chronic pain (n = 24)	NR	Male: 6 Female: 18	Waitlist	6 weekly WHEE sessions	Clinical and psychiatrist
Rostaminejad et al.,²⁰ 2017	Iran	RCT	Phantom limb pain (n = 60)	42.8	Male: 42 Female: 18	Routine care	12 1-h EMDR sessions for 1 month	EMDR-trained therapist
Nia et al.,²¹ 2018	Iran	Multiarm RCT	Rheumatoid arthritis (n = 75)	45.4 (11.3)	Male: 11 Female: 64	Treatment as usual	6 GI sessions; 6 45- to 90-min EMDR sessions	NR
Corsetti et al.,²³ 2020	Italy	Case control	Autoimmune condition (n = 45)	Treatment: 47.7 (11.5) Control: 49.7 (11.4)	Male: 3 Female: 42	Treatment as usual	Tandem psychotherapy EMDR and group therapy	Group therapy specialist, psychotherapist, psychologist, and psychodynamic therapy trainer
Suárez et al.,¹⁴ 2020	Spain	RCT	Treatment-resistant mild to moderate chronic nonmalignant pain (n = 28)	55.07 (8.83)	Male: 6 Female: 22	Treatment as usual	12 90-min EMDR sessions for 3 months	Spanish EMDR Association-trained therapists (>5 years experience)
Abdi et al.,¹⁵ 2021	Iran	RCT	Cancer and moderate-to-severe pain (n = 60)	51.50 (7.84)	Male: 32 Female: 28	Treatment as usual	6–8 daily 1-h EMDR sessions	EMDR-trained psychotherapists (5–10 years experience)
Zat Çiftçi et al.,²² 2024	Turkey	RCT	Chronic fibromyalgia (n = 64)	44 (12.46)	Male: 4 Female: 60	Treatment as usual	15 75–90 min EMDR sessions	Clinical and psychiatry EMDR-trained therapist

EMDR, eye movement desensitization and reprocessing; GI, guided imagery; NR, not reported; RCT, randomized clinical trial; SD, standard deviation; WHEE, wholistic hybrid derived from eye movement desensitization and reprocessing and emotional open-accessdom techniques.

Table 2.

Results of the Included Studies

Article	Primary pain metric	Other measured outcomes	Time of assessment	Key findings
Gerhardt et al.,¹⁸ 2016	NRS (mean pain intensity in past 4 weeks)	Disability with MPI-D Patient perspective with PGIC	Immediately after treatment; 6-month follow-up	Pain intensity significantly improved immediately after treatment (45% of patients had ≥30% improvement) but was not significant at 6 months Disability did not significantly change Half of patients reported clinical improvement immediately after treatment (vs. 0% in control group), and 40% of patients reported clinical improvement at 6-month follow-up (vs. 0% in control group)
Sinici,²⁴ 2016	MMPQ	Anxiety with SAI Depression with BDI Distress with SCL-90-R	Immediately after treatment; 1-month and 3-month follow-up	Significantly improved pain between first and second treatment but not after subsequent session; pain reduction maintained at follow-up
Benor et al.,¹⁹ 2017	BPI-severity, BPI-interference	Depression with BDI-II Anxiety with SAS	During treatment; 1-month and 3-month follow-up	Decreased anxiety (p < 0.05) and depression (p < 0.05) for initial WHEE group Decreased pain severity (p < 0.05) and depression (p < 0.04) but not pain interference or anxiety for wait-listed patients crossed over to WHEE
Rostaminejad et al.,²⁰ 2017	NRS (current pain intensity)	Distress with SUDS	Immediately after treatment; 24-month follow-up	Decreased pain between first and last treatment, sustained at 24-month follow-up No change for control group (p < 0.001) Minor or no phantom limb pain immediately after treatment (13.3%) and at 24-month follow-up (6.7%) vs. 100% in control group
Nia et al.,²¹ 2018	RAPS	Physiological outcomes and affective, sensory-discriminative, and cognitive pain with RAPS subscales	2-week follow-up	Significantly decreased mean pain score for EMDR and guided imagery groups (p = 0.001)
Corsetti et al.,²³ 2020	SF-36	Distress and psychological symptoms with SCL-90-R (including GSI) Traumatic or stressful life events with LSC-R	Before treatment; immediately after treatment; 6-month follow-up	Greatly improved GSI score (p < 0.001), depression (p < 0.001), and anxiety (p < 0.001) with intervention (vs. control)
Suárez et al.,¹⁴ 2020	VAS for pain severity and PDI for pain interference	Quality of life with EQ-5D-5L and EQ VAS Anxiety/depression with HADS	Immediately after treatment; 3-month follow-up	Significantly reduced VAS (p < 0.001) and PDI (p = 0.001) scores; improved quality of life, anxiety, and depressive symptoms immediately after treatment and 3-month follow-up Large effect size for VAS and PDI scores
Abdi et al.,¹⁵ 2021	NRS (current pain intensity)	Distress with SUDS	Immediately after treatment; 2-month follow-up	Significantly reduced mean NRS and SUDS scores before and after EMDR intervention (p < 0.001) No change in control group for NRS (p = 0.72) or SUDS (p = 0.64) scores Significant differences in pain scores between groups (p < 0.001)
Zat Çiftçi et al.,²² 2024	VAS (pain intensity), FIQ, WPI, SSS	Beck Depression Inventory, PSQI, TSC-40	Pre- and post-test measures after sessions 5, 10, and 15; 1-month and 3-month follow-up	Significant difference in VAS (p < 0.001), FIQ (p < 0.001), WPI (p < 0.001), BDI (p < 0.001), and PSQI (p < 0.001) after sessions 5, 10, and 15 and at 1-month and 3-month follow-ups

BDI, Beck Depression Inventory; BDI-II, Beck Depression Inventory-II; BPI, Brief Pain Inventory; EMDR, eye movement desensitization and reprocessing; EQ-5D-5L, EuroQol 5-Dimension 5-Level instrument; EQ VAS, EuroQol visual analog scale; FIQ, Fibromyalgia Impact Questionnaire; GSI, Global Severity Index; HADS, Hospital Anxiety and Depression Scale; LSC-R, Life Stressor Checklist-Revised; MMPQ, McGill-Melzack Pain Questionnaire; MPI-D, West Haven-Yale Multidimensional Pain Inventory-Disability; NRS, numerical rating scale; PDI, Pain Disability Index; PGIC, Patient Global Impression of Change; PSQI, Pittsburgh Sleep Quality Index; RAPS, Rheumatoid Arthritis Pain Scale; SAI, State Anxiety Inventory; SAS, Zung Self-Rating Anxiety Scale; SCL-90-R, Symptom Checklist-90-Revised; SF-36, 36-Item Short-Form Health Survey; SSS Symptom Severity Scale; SUDS, Subjective Units of Distress Scale; TSC-40, Trauma Symptom Checklist-40; VAS, visual analog scale; WHEE, wholistic hybrid derived from eye movement desensitization and reprocessing and emotional open-accessdom techniques; WPI, Widespread Pain Index.

The included studies focused on EMDR treatment of a few predominant types of chronic pain: cancer pain (one study¹⁵), phantom limb pain (two studies^20,24), autoimmune disorder-associated pain (two studies^21,23), fibromyalgia (one study²²), and nonspecific pain (three studies^14,18,19). All studies targeted pain and painful memories. Rostaminejad et al.²⁰ focused on injury-related memories, whereas Suárez et al.¹⁴ addressed broader trauma and somatic symptoms, and Gerhardt et al.¹⁸ considered future pain. Sinici²⁴ studied pain representation (type, intensity, smell, and heat) and its impact on beliefs, emotions, and personality. Although six of the studies provided some details about therapist experience,^{14,15,18–20,23} measures of treatment fidelity (e.g., EMDR Fidelity Rating Scale scores) were not reported in any of the studies.

The EMDR-based interventions investigated in most studies (eight out of nine) followed the traditional 8-step EMDR protocol.^{14,15,18,20–24} In contrast, Benor et al.¹⁹ used combined emotional open-accessdom techniques (EFT) and EMDR, collectively known as the wholistic hybrid derived from EMDR and EFT (WHEE). The sample sizes in the studies were low, ranging from 14 to 75 participants. The largest EMDR treatment groups were cohorts of 36 participants.^15,22

The outcomes of pain and quality of life were measured in six of seven RCTs (86%).^{14,15,18,20–22} The seventh RCT¹⁹ did not report pain values for both treatment and control groups; therefore, determination of the effect size was not possible.

Risk of bias

Among the seven RCTs, four had some concerns for risks of bias, and two had a high risk of bias according to the RoB 2 tool (Fig. 2). The primary risks of bias were measurement of outcome (four RCTs^14,18,19,21) and deviation from the intended intervention (three RCTs^15,18,20). The study by Gerhardt et al.¹⁸ compared an EMDR treatment group with a wait-listed control group, rather than another intervention or standard-of-care group. This study design resulted in an increased risk of overestimating the treatment effect. In addition, two RCTs reported a dropout rate of greater than 15% of participants.^14,19

FIG. 2.

Traffic light plot of risk of bias using the Cochrane Risk of Bias 2 tool.

The ROBINS-I tool was used for the two non-RCT articles (Table 3).^23,24 One article had a serious risk of bias due to confounding because of differing dropout rates, history of childhood trauma, psychiatric illnesses, and autoimmune disease distribution.²³ The other article had a moderate risk of bias due to classification of the intervention because the number of EMDR sessions the patients underwent was not clearly defined.²⁴

Table 3.

Risk of Bias in Observational Studies Included in the Systematic Review^a

	Bias domain
Article	Confounding	Selection of participants	Classification of interventions	Deviations from intended intervention	Missing data	Selection of reported result	Overall risk of bias
Sinici,²⁴ 2016	Low	Low	Moderate	Low	Low	Low	Moderate
Corsetti et al.,²³ 2020	Serious	Low	Moderate	Moderate	Moderate	Moderate	Serious

The Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess risk of bias according to six domains of bias.

Pain outcomes

All nine studies reported improvements in pain with EMDR treatment. Effect size estimates were calculated for the six studies that reported quantitative pain outcomes for the treatment and control arms at the latest follow-up times^{14,15,18,20–22} (Table 4). Only one study had a small and statistically nonsignificant effect size (Hedges g, 0.50; 95% CI, –0.14 to 1.12).¹⁸ Three studies^14,15,20 reported a large effect size (Hedges g, ≥1.49), and one study²¹ reported a moderate effect size (Hedges g, 0.79; 95% CI, 0.14–1.49).

Table 4.

Treatment Effect Size at the Latest Follow-up Time for Randomized Clinical Trials of EMDR Treatment of Chronic Pain

Article	Pain metric	Follow-up duration	Mean (SD) pain score		Hedges g (95% CI)	Interpretation
Article	Pain metric	Follow-up duration	EMDR group	Control group	Hedges g (95% CI)	Interpretation
Gerhardt et al.,¹⁸ 2016	NRS	6 months	3.80 (2.24)	4.90 (2.17)	0.50 (–0.14 to 1.12)	Small, nonsignificant
Rostaminejad et al.,²⁰ 2017	NRS	24 months	2.25 (1.37)	8.06 (1.25)	4.28 (3.22 to 5.37)	Large
Nia et al.,²¹ 2018	RAPS	2 week	2.9 (1.8)	4.6 (2.7)	0.79 (0.14 to 1.49)	Moderate
Suárez et al.,¹⁴ 2020	VAS	3 months	2.64 (1.35)	5.64 (2.41)	1.49 (0.67 to 2.37)	Large
Abdi et al.,¹⁵ 2021	NRS	2 months	3.70 (1.57)	9.70 (0.59)	4.38 (3.31 to 5.59)	Large
Zat Çiftçi et al.,²² 2024	VAS	3 months	12.18 (17.30)	26.2 (17.65)	0.79 (0.28 to 1.31)	Moderate

CI, confidence interval; EMDR, eye movement desensitization and reprocessing; NRS, numerical rating scale; RAPS, Rheumatoid Arthritis Pain Scale; SD, standard deviation; VAS, visual analog scale.

All nine studies reported baseline pain measurements, and six reported pain measurements immediately after the EMDR intervention (Table 2).^{14,15,18,20–22} Follow-up periods for all nine studies ranged from 2 weeks to 24 months. A numerical rating scale for pain was the most frequent metric used to assess pain outcomes (three studies^15,18,20). The other six studies used various outcome measures, including the Rheumatoid Arthritis Pain Scale,²¹ McGill-Melzack pain questionnaire,²⁴ Brief Pain Inventory,¹⁹ 36-Item Short-Form Health Survey,²³ visual analogue scale,¹⁴ EuroQol 5-Dimension 5-Level instrument,¹⁴ Pain Disability Index,¹⁴ EuroQol visual analog scale,¹⁴ Fibromyalgia Impact Questionnaire,²² and Widespread Pain Index.²²

One study evaluated treatment with EMDR for cancer-associated pain. Abdi et al.¹⁵ showed that EMDR significantly decreased mean (SD) pain intensity scores immediately after treatment and at a 2-month follow-up (3.70 [1.57]) and lowered pain scores (9.70 [0.59]), as compared with a control group, in a cohort of 60 patients with cancer who had moderate-to-severe pain.

Two studies investigated EMDR treatment of phantom limb pain.^20,24 Sinici²⁴ reported that EMDR reduced phantom limb pain in a prospective cohort of 14 patients, with a significant decrease in mean (SD) pain scores from the first session (7.07 [1.5]) to 3 months after EMDR (0.07 [0.3]) (p < 0.001). Rostaminejad et al.²⁰ conducted an RCT with 60 patients and reported that pain scores decreased immediately after EMDR treatment and at 24 months after treatment (p < 0.001).

Two studies examined the efficacy of EMDR for the treatment of autoimmune disorder — related pain.^21,23 Corsetti et al.²³ performed a case-control study of tandem psychotherapy (i.e., EMDR and group therapy) for the treatment of patients with autoimmune disorders. For the 24 patients in the treatment group, the seven quality-of-life domains measured, except physical function (p = 0.08), were significantly improved immediately after treatment and at a 6-month follow-up assessment (p < 0.05), when compared with a control group. Nia et al.²¹ compared pain outcomes among three groups (n = 25) of patients with rheumatoid arthritis who underwent guided imagery (i.e., mind-body therapy that influences autonomic balance by promoting endorphin release and distraction) versus EMDR versus control. The groups who underwent guided imagery or EMDR, but not the control group, had a statistically significant decrease in pain scores (p < 0.001). In addition, EMDR was more effective than guided imagery for reducing pain (p < 0.001).

One article reported on the use of EMDR for the treatment of fibromyalgia.²² Zat Çiftçi et al.²² compared a standard-of-care treatment versus EMDR in addition to the standard-of-care treatment for 79 participants. Analysis of variance with repeated measures for multiple follow-up intervals indicated a statistically significant group effect on pain intensity (p = 0.02), depression (p = 0.02), and childhood and adult trauma (p = 0.02) with the addition of EMDR. After applying Bonferroni correction, EMDR remained an effective treatment according to all measures used in the study (p < 0.05).

Three studies reported on the efficacy of EMDR for the treatment of nonspecific pain.^14,18,19 Suárez et al.¹⁴ reported significantly decreased mean (SD) pain severity scores from baseline (5.14 [1.10]) to 3 months after EMDR treatment (2.64 [1.35], p < 0.001) for 28 patients with treatment-resistant chronic nonmalignant pain. The patients who underwent EMDR also had statistically significant decreases in pain interference, anxiety, and depression scores. Quality of life was higher for the treatment group than for the control group when measured with the EuroQol 5-Dimension 5-Level instrument but not with the EuroQol visual analog scale. The improvements in pain and quality of life for the EMDR group were sustained at the 3-month follow-up assessment, indicating long-term efficacy of EMDR.

Gerhardt et al.¹⁸ tested the efficacy of EMDR for the treatment of pain for 40 patients with previous exposure to at least one psychologically traumatic event. Mean (SD) pain intensity scores were significantly decreased, as compared with a control group, immediately after EMDR treatment (3.88 [2.15] vs. 5.45 [1.82]) but not at a 6-month follow-up assessment (3.80 [2.24] vs. 4.90 [2.17]). However, 9 of 20 patients reported improvements in pain intensity of 30% or greater.

Benor et al.¹⁹ conducted a crossover RCT with 24 patients who underwent WHEE for chronic pain, with wait-listed patients as the control group. WHEE did not decrease pain scores for the immediate intervention group in the randomized phase of the trial. For the wait-listed patients who were crossed over to the WHEE intervention, pain severity scores were decreased at 4- and 6-week post-treatment assessments (p < 0.05), but this outcome did not persist at 1- and 3-month follow-up assessments. This crossover group also had significantly decreased depression scores (p < 0.05) but not for pain interference or anxiety.

Other outcomes

The studies also assessed outcomes other than pain (Table 2), such as psychological distress (Symptom Checklist-90-Revised in two studies,^23,24 Subjective Units of Distress Scale in two studies,^15,20 and Global Severity Index in one study²³), anxiety (Zung Self-Rating Anxiety Scale in one study,¹⁹ State Anxiety Inventory in one study,²⁴ and Hospital Anxiety and Depression Scale in one study¹⁴), depression (Beck Depression Inventory in three studies^19,22,24 and Hospital Anxiety and Depression Scale in one study¹⁴), disability (West Haven-Yale Multidimensional Pain Inventory-Disability in one study¹⁸), patient perspective (Patient Global Impression of Change in one study¹⁸), quality of life (EuroQol 5-Dimension 5-Level instrument in one study¹⁴ and 36-Item Short-Form Health Survey in one study²³), and traumatic life events (Life Stressor Checklist-Revised in one study²³).

In the study by Gerhardt et al.,¹⁸ the effect size of EMDR for disability was not significant, although 10 of 20 patients in the EMDR group reported clinical improvement. Benor et al.¹⁹ reported a significant decrease in depression scores with EMDR but not for distress or anxiety. Rostaminejad et al.,²⁰ Corsetti et al.,²³ Abdi et al.,¹⁵ and Suárez et al.¹⁴ all reported significantly decreased psychological distress scores after EMDR treatment. Suárez et al.¹⁴ also noted improved quality of life, anxiety, and depressive symptoms immediately after EMDR treatment and at a 3-month follow-up assessment. Sinici²⁴ reported significantly reduced anxiety, depression, and psychological distress, with decreased scores for all subscales of the Symptom Checklist-90-Revised, except for the anger-hostility subscale.

None of the included articles reported information about adverse events, except Suárez et al.,¹⁴ which reported no adverse events in their study.

Discussion

In a systematic review of articles published during the past decade, nine clinical trials of EMDR treatment for chronic pain conditions were identified. All nine studies reported significantly greater improvement in pain symptoms for patients who underwent EMDR treatment than for those in control groups. Notably, the studies using a numerical rating scale showed not only statistically significant improvements but also clinically meaningful improvements for patients who underwent EMDR.^25,26 The treatment effect sizes varied among the studies, which was most likely due to the diverse pain scales used. In addition, the positive effects were consistently observed either immediately after an initial EMDR session or during the subsequent follow-up period, which generally occurred shortly thereafter. Notably, only one study had a follow-up period extending beyond 6 months.²⁰ This finding highlights a considerable limitation of studies in this field—that little is known about the long-term efficacy of EMDR. Understanding longer-term effects will require future trials.

Chronic pain, regardless of its cause, can considerably affect overall function for patients.^1,2 Chronic pain may also be exacerbated by psychological factors.³ Incorporating integrative therapies that address mental health, in addition to conventional treatments, may help yield positive outcomes for patients. As clinicians seek different options for treating their patients, EMDR should be considered as a possible additional integrative method to address chronic pain.

The findings of this review also highlight the positive effect of EMDR on mental health symptoms, such as anxiety, depression, or stress, for patients who concurrently have chronic pain. This underscores the potential of EMDR to address mental health issues while simultaneously targeting pain pathways. Previously published systematic reviews have reported on the efficacy of EMDR for treating various mental health conditions, including PTSD, anxiety disorders, and depression, although many of these studies are limited by biases.

Four previously published systematic reviews assessed the efficacy of EMDR treatment of various pain and mental health conditions.^12,13,27,28 However, the inclusion criteria used in those reviews were broad and not rigorous, often including case reports. Nevertheless, each of those reviews reported positive effects of EMDR for the treatment of pain. In 2009, van Rood and de Roos²⁷ reported a benefit of EMDR for medically unexplained symptoms, phantom limb pain, and somatoform disorders on the basis of findings from one RCT and 15 studies lacking control groups. In 2016, Tefft and Jordan¹³ summarized findings from 28 studies, which included three RCTs published in 1994, 2002, and 2008. Their findings highlighted a role of EMDR in the treatment of phantom limb pain, complex regional pain syndrome, medically unexplained symptoms, and chronic fatigue syndrome. Tesarz et al. conducted a systematic review in 2014¹² and an updated review in 2019.²⁸ The 2014 review included 2 RCTs and 10 observational studies, and the 2019 updated review incorporated an additional four RCTs. The findings of those studies also highlighted the efficacy of EMDR for the treatment of such conditions as headache and postoperative pain in adolescents. Those reviews also emphasized the necessity for rigorous clinical trials due to limitations in existing studies, such as a lack of active control groups and small sample sizes. Moreover, the previous reviews emphasized the importance of understanding the mechanism of EMDR in pain treatment for better clinical application, suggesting its efficacy may relate more to associations between pain symptoms and stress.

In a 2018 case series of seven patients with fibromyalgia, Kavakçı et al.²⁹ reported that EMDR treatment led to statistically significant improvements in pain levels with five different pain scales (p < 0.005), sleep quality, depression, PTSD symptoms, and anger management. The number of tender points decreased significantly (p < 0.05), and most patients no longer met the criteria for fibromyalgia after EMDR treatment, suggesting the effectiveness of EMDR therapy for this condition. The findings of this and other previously published studies suggest that EMDR may be an effective tool for treating chronic pain. In some of these cases (e.g., phantom limb pain and cancer-associated pain), pain may be the therapeutic input rather than underlying trauma or stress; thus, the pain itself may be a source of trauma for some patients. In such cases, EMDR protocols that specifically target pain rather than an underlying traumatic memory may be needed, although this is currently unclear. Another notable finding in our study was that studies with higher baseline pain intensity—such as those including patients with cancer or phantom limb pain—tended to report larger effect sizes. This pattern is consistent with the findings of trials of nonpharmacologic and pharmacologic therapies, in which baseline pain severity influenced treatment outcomes.^30,31

In 2024, Oguchi et al.³² conducted a scoping review of psychologically based interventions for chronic neuropathic pain, identifying 33 studies, including 13 randomized controlled trials. Although approximately 63% of the included studies reported improvements in pain outcomes, the authors noted that the evidence base remains limited due to variable methodological quality and the narrow focus on specific conditions.

The current systematic review has some limitations of note. A limited number (n = 9) of studies were identified via a rigorous search strategy. Of these, most had small-to-moderate sample sizes and used various study methods. The variable treatment effect sizes observed among the included studies are due to not only heterogeneity in the types of chronic pain investigated (i.e., neuropathic, nociplastic, and mixed pain) and severity of pain intensity but also to the different scales used to measure pain and a lack of placebo-equivalent controls. This variability hinders the generalization of our findings to the broader population of patients with chronic pain and precludes the pooling of outcomes for meta-analysis. Furthermore, several of the included studies omitted key methods and introduced risks of bias (i.e., single center, lack of blinding, variability in outcome measures, confounding variables, high dropout rates, and deviation from the intended intervention). We also did not include studies that involved group-based EMDR interventions in this review to improve homogeneity among findings, although recent studies have indicated positive outcomes for EMDR-derived techniques used in a group setting.^33,34 Nevertheless, the findings of this systematic review provide comprehensive insights from various perspectives, focusing primarily on pain management by exclusively considering studies involving chronic pain and recently published data. The risk of bias was meticulously assessed, and the estimated treatment effect sizes were synthesized from relevant studies, facilitating a robust interpretation of the role of EMDR in pain management.

The diverse types of pain treated with EMDR underscore the need for tailored approaches in clinical practice, with future research aiming to elucidate the most effective protocols for different patient populations. Although the present review contributes to the increasing evidence base supporting the efficacy of EMDR for pain management, ongoing research efforts are essential to refine treatment protocols and address questions regarding its practical implementation in various clinical settings.

Conclusions

Patients who underwent EMDR for chronic pain conditions had greater improvements than those who underwent control treatment. This finding was evident with a range of metrics, including pain severity, pain interference/disability, anxiety, depression, and quality of life. EMDR is an increasingly popular integrative treatment strategy for various conditions. Although these findings align with those of previous reviews supporting the effectiveness of EMDR for various pain conditions, it is important to note that the reviewed studies included relatively small patient samples, used heterogeneous metrics to assess outcomes, and consequently introduced a potential risk of bias. Although EMDR shows promise for reducing pain intensity and addressing psychological distress, further research with rigorous scientific methods is needed to confirm these effects and provide a more balanced assessment of its clinical application.

Authors’ Contributions

A.S.: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, and writing—review and editing. P.F.: Formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—original draft, and writing—review and editing. K.A.: Formal analysis, investigation, methodology, validation, and writing—review and editing. L.T.: Methodology, validation, visualization, writing—original draft, and writing—review and editing. Z.A.: Data curation, methodology, writing—original draft, and writing—review and editing. A.M.B.: Data curation, writing—original draft, and writing—review and editing. C.V.A.: Conceptualization, supervision, visualization, writing—original draft, and writing—review and editing. R.T.H.: Supervision and writing—review and editing. L.M.P.: Supervision, validation, visualization, and writing—review and editing. A.B.M.: Conceptualization, investigation, resources, supervision, validation, visualization, and writing—review and editing.

Footnotes

Acknowledgments

Nisha Badders, PhD, ELS, Mayo Clinic, substantively edited the article. The Scientific Publications staff at Mayo Clinic provided proofreading and administrative and clerical support.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

Data Availability

All relevant data supporting the findings of this study are reported in the article.

Supplemental Material

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