EMDR for Chronic Pain: What the Evidence Shows

Some clients bring chronic pain into the room alongside trauma, and a growing number of clinicians have tried applying EMDR to pain itself, not just its psychological aftermath. Here's what the actual research says — where the evidence holds up, where it's still thin, and what that means for how you talk about it with clients.

Why EMDR gets applied to pain

EMDR’s core mechanism targets memories and their associated distress, but chronic pain often carries its own emotional charge: memories of an injury, medical trauma, or the accumulated frustration of a condition that hasn’t resolved. Clinicians who extend EMDR to pain are typically not claiming to treat the underlying physical pathology — they’re targeting the distress, fear, and unprocessed material that can amplify a client’s experience of pain. That’s a meaningfully different claim than “EMDR cures pain,” and it’s worth being precise about the distinction with clients and referring providers alike.

What the systematic review found

The most cited systematic review on this topic is a 2014 paper in Pain Medicine that screened the major databases — MEDLINE, EMBASE, the Cochrane Library, and others — for every study that used EMDR to treat chronic pain. It found two controlled trials (80 participants combined) and ten observational studies (116 participants combined) that met its inclusion criteria (Tesarz et al., 2014, Pain Medicine).

The findings were encouraging on the surface: the controlled trials showed statistically significant improvements in pain intensity with large effect sizes, and the observational studies showed effects ranging from small to very large across pain intensity, disability, depression, and anxiety measures. Follow-up assessments in these studies showed the improvements held over time, and no adverse events were reported.

The review’s own conclusion, though, is the part worth repeating to colleagues and clients: “the small number of high-quality studies leads to insufficient evidence for definite treatment recommendations.” Two controlled trials is not a large evidence base, and the review’s authors were explicit that promising is not the same as proven.

Which pain conditions have been studied

Across the studies included in that review and the case literature since, EMDR has been applied to a range of pain presentations: chronic musculoskeletal pain and back pain, headaches, phantom limb pain, fibromyalgia, and rheumatoid arthritis. A more recent pilot study describing an intensive outpatient group EMDR program for chronic pain patients reported that no group EMDR chronic-pain research existed prior to their own program design — underscoring how young this specific application still is, even though EMDR for pain in general has been studied since the early 2000s (Frontiers in Psychology, 2024). That pilot reported high feasibility and no relevant side effects, but it was explicitly exploratory rather than a controlled trial.

Practical considerations for remote sessions

If you’re considering EMDR for a client’s pain-related distress, the delivery mechanics over video are the same as any other remote EMDR session — nothing about targeting pain-related memories changes how bilateral stimulation is delivered. A few things are worth keeping in mind specifically for this population:

• Screen for medical clearance and collaboration. Chronic pain clients are often already working with a physician or physical therapist. Coordinating care, and being clear about what EMDR is and isn’t claiming to treat, protects the client and your practice.
• Expect slower stabilization. Clients who have lived with pain for years often carry a large stock of frustration, medical-system fatigue, and grief alongside the pain itself. Building resources before reprocessing — see our guide to resource development and installation — is often worth the extra time.
• Track SUD carefully, and separately from pain scores. SUD measures emotional disturbance about a target, not physical pain intensity. Keep the two distinct in your notes so you’re not conflating a drop in disturbance with a drop in pain.
• Set realistic expectations up front. Given the state of the evidence, it’s fair to describe this work as targeting the distress and traumatic material connected to the pain experience, while being honest that EMDR is not a validated stand-alone pain treatment the way it is for PTSD.

How this fits with the rest of your caseload

Most clinicians who use EMDR for pain-related distress aren’t running a separate pain protocol — they’re applying the same eight-phase structure they already use for trauma, with the target simply reframed around the pain experience: the moment of injury, a frightening diagnosis, a dismissive medical encounter, or the cumulative toll of living with unresolved pain. That continuity is useful to name for clients, since it means nothing about the delivery format changes. The eight phases of EMDR still apply in full, including history-taking, resourcing, and reevaluation, whether the target memory involves an assault or a decade of chronic back pain.

It’s also worth documenting your reasoning for extending EMDR into this territory, particularly given how thin the controlled-trial evidence still is. A short note on why you and the client agreed to try it, what you’re targeting specifically, and how you’re both defining a successful outcome gives you a clear record if a referring physician or a future clinician asks how the work was framed.

The bottom line

EMDR for chronic pain sits in a familiar place for anything at the edge of an established protocol: real, published, encouraging signals, and not yet enough high-quality evidence to call it settled. That’s a reasonable basis for offering it as one option among several, with informed consent that’s honest about where the evidence currently stands — and it’s worth revisiting the literature periodically, since group and intensive-format studies are still emerging.