Middle Eastern Journal of Disability Studies

Background: Limb amputation is often an inevitable procedure in the advanced condition of various diseases, which may result in trauma or infection with a dramatic impact on a patient’s life. After the physical loss of a limb, patients experience several limitations. Limp amputation disturbs the integrity of the human body and causes low self-esteem due to reduced mobility and pain. Central nervous system changes seem to be the major determinant of phantom-limb pain, though psychological factors may influence the outcome. The two main aspects of one’s perception of his/her appearance are body image and self-esteem. The importance of the concepts of body image and self-esteem lies in the fact that a person feels that his or her body image will affect interactions, playing a significant role in his/her social and interpersonal relationships. A new therapy that emerged independently of neuroscience, though it coheres well with the kind of approach implied by neuroscience, is Eye Movement Desensitization and Reprocessing (EMDR). In this method, change is driven by a combination of bottom-up sensory stimulation and top-down attention processes and cognitive reevaluation. The aim of this study was to investigate the effect of systematic desensitization and reprocessing on pain, body image and self-esteem in amputees with phantom limb pain.

Materials & Methods: This quasi-experimental study was conducted in 2015 and 2016 in Iranian Red Crescent Society - Tehran Province. The participants were recruited through purposive sampling. A total of 47 amputees who suffered from phantom limb pain were selected initially, of whom 39 patients were judged to meet the inclusion criteria.  Yet, only 26 patients continued to participate in the research project up to the final assessment phase. In order to protect the participants’ rights, the participants were asked for a written consent for participating in the research project.  Then, using the random placement method, the researchers assigned half of the participants to the EMDR condition (N=13), namely, intervention group, while the rest were assigned to the control group (N=13). The EMDR method was applied for each patient individually at consultation room of Technical orthopedic clinic (Arsham Teb Clinic in Tehran) during weekly 90 minute sessions for ten weeks. The dependent variables included the results of pain intensity tests, body image and self-esteem, which were measured in the intervention and control groups in similar and double-blind conditions.

Psychological questionnaires including revised scale in Body-Self Relations Questionnaire (MBSRQ), the Rosenberg Self-esteem (RSE) & Mc-Gill Pain Questionnaire (SF-MPQ-2) were administered to the patients. The intervention group was treated for 10 sessions (90 minutes each session) with Eye movement Desensitization and Reprocessing (EMDR), while the control group received only the Treatment-As-Usual (TAU), namely, talk therapy. Various statistical tests including partial correlation and MANCOVA were utilized.

Results: Covariance analysis results indicated that the pre-test and post-test difference score among the two intervention and control groups in three areas of pain (F=177.2  and p<0.001), self-esteem (F=24.54  and p<0.001) and self-image (F=199.01  and p<0.001) is statistically significant. The results indicate a significant decrease in pain and increase in self-esteem and body image satisfaction.

Pearson correlation was used to investigate the relationship between the variables under investigation by sub-criteria (P <0.001) to find out whether the relationship between the variables of self-esteem and body image is directive or it is caused by influence of pain variable. The partial correlation between self-esteem scores and body image after the removal of pain  showed that after omitting the effect of phantom pain, EMDR  was statistically significant correlated with self-esteem and body image in two subscales, namely, Appearance Orientation and Fitness Orientation (p<0.05). However, EMDR  was not statistically significant  correlated the other four subscales, namely, Appearance Evaluation, Fitness Evaluation, Body Areas Satisfaction Scale, Self-classified Weight). The results suggest that the relationship between the above mentioned variables is due to pain reduction.

Conclusion: The obtained results revealed that Eye Movement Desensitization and Reprocessing reduced phantom limb pain in amputated patients. Besides, it was revealed that it was an effective therapy for improving self-esteem and body image. Therefore, its use as a therapeutic and alleviative method could be suggested for patients suffering from phantom limb pain. Unexpectedly, the partial correlation results showed this treatment does not have any direct effect on self-esteem and body image. To sum up, by reducing dysfunctional cognition about disability and amputation, EMDR therapy can also reduce phantom limb pain and perception of defects and dissatisfaction of body while enhancing self-esteem. Yet, in the absence of pain reduction, it is not effective on some self-image dimensions.