Emotional Freedom Technique Programs May Modulate Stress to Reduce Chronic Pain

Intervention programs that incorporate the Emotional Freedom Technique (EFT) may constitute a safe, effective psychologic approach in managing chronic pain in adults, according to study results published in the European Journal of Pain.

Chronic pain affects approximately 20% of adults in the United States at some point during their lifetime, but data are limited regarding safety and effectiveness of current pharmaceutical and surgical treatments for this condition. EFT, also known as tapping or psychologic acupressure, is an evidence-based, clinically validated self-administered intervention that combines exposure therapy and cognitive therapy with percussive stimulation of acupressure points with the fingertips. During EFT sessions, participants vividly recall an aversive event by describing it, and then respond by expressing their self-acceptance. Patients rate the emotional intensity of the event on an 11-point Likert scale, both before and after tapping.

The effectiveness of EFT may be related to its modulation of physiologic systems that regulate stress. Studies have shown that EFT reduces cortisol levels substantially and can be used successfully to treat anxiety, depression, post-traumatic stress disorder, and fibromyalgia.

To assess EFT effectiveness in controlling chronic pain and enhancing patients’ sense of well-being, researchers in Australia conducted a randomized trial of an EFT program offered to adults online in a self-paced format or via an in-person Zoom meeting. They also compared the effectiveness of these 2 EFT delivery formats against results observed in a waitlist control group.

Treatment with EFT consisted of a 2-hour session given weekly for 6 weeks. In the in-person EFT group, 2 trained EFT practitioners, including a clinical psychologist, conducted the sessions via Zoom calls, based on standardized protocols. In the self-paced online EFT group, patients viewed and interacted with prerecorded modules at their own pace, with each module released on a week-by-week basis. Participants were instructed to tap acupressure points on the eyebrow, side of the eye, under the eye, under the nose, on the chin and collarbone, under the arm, and on top of the head.

English-speaking patients who had chronic pain without a clear organic cause that had negatively affected their general functioning and quality of life (QOL) for at least 6 of the last 12 months were eligible for inclusion in the trial. Additionally, patients had to have rated their current pain as a 4 or higher on an 11-point (0 to 10) visual analogue pain scale. Patients who had autoimmune disease or a history of psychologic impairment, were being treated for cancer or substance use disorder, or were receiving psychologic or surgical treatment for chronic pain were excluded from the trial.

A total of 147 adults were enrolled in the trial; 89.9% were women and mean patient age was 54.63 years.

The Brief Pain Inventory (BPI) short form was used to measure pain severity and interference with functioning; responses were evaluated for 4 pain severity items and 7 pain interference items. The BPI uses a 0- to 10-point linear scale, with 0 representing “no pain” and 10 representing “pain as bad as you can imagine.” Based on patient responses, the investigators calculated a mean score for pain severity and for interference of pain with activities. Other measurements included self-ratings of QOL, satisfaction with life, and happiness, as well as Patient Health Questionnaire scores regarding anxiety, depression, and somatic symptoms.

Results of the per-protocol analysis showed that, among patients who completed the 6-week EFT programs, mean scores for pain severity and interference of pain with activities were significantly lower than the pretreatment scores (all P<.001); this was not the case in the waitlist groups. Simple main effect contrasts showed pain severity was significantly lower at post-test vs pretest for both in-person EFT (mean difference, 5.25; P <.001) and self-paced EFT (mean difference, 4.80; P <.001) but not the waitlist condition. Regarding pain interference, post-test scores were significantly lower for patients in the in-person EFT (mean difference, 11.41; P <.001) and self-paced EFT (mean difference, 11.88; P <.001) groups but not for those in the waitlist group.

At the 6-month follow-up visit, these between-group differences were still evident. However, there were no differences in pain severity and interference scores between patients who completed the in-person EFT program vs online self-paced EFT.

After EFT, scores for somatic symptoms were lower (P <.01) and QOL scores were higher (P <.001) than preintervention scores; these findings were sustained at the follow-up visit. There were no between-group differences in number of somatic symptoms or QOL scores.

Both immediately postintervention and at 6-month follow-up, no statistically significant effects of either the in-person or online EFT intervention were found in terms of scores for anxiety, depression, happiness, and satisfaction with life.

Limitations of this study include patients’ ability to select the type of program they preferred, which may have biased the randomization process. In addition, because the EFT groups included a considerably higher percentage of women, the study sample may not adequately reflect the overall population of patients with chronic pain. Given the wide variety of chronic pain conditions evaluated, it was not possible to determine EFT effectiveness against specific chronic pain types. Missing data curtailed the statistical power to evaluate differences in measures at the 6-month follow-up visit, and patient allocation to the various study arms favored EFT treatment over the control group and the in-person EFT group over the online, self-paced EFT group.

Importantly, multiple comparisons were made in this study; therefore, despite application of the Bonferroni correction, there was an increased probability of detecting a statistically significant difference by chance alone and the results should be interpreted with caution.

The investigators concluded, “[These] findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes.” They added, “By investigating the effectiveness of EFT on improving sufferers’ pain and psychological well-being, the current study adds to the growing body of literature presenting EFT as a potentially effective pain management strategy with very little downside.”

This article originally appeared on Clinical Pain Advisor