Psychological Treatment Provides Pain Relief for Chronic Back Pain

66 percent of patients randomly assigned to pain reprocessing therapy were pain-free after treatment compared with 20 percent in placebo group

HealthDay News — For patients with chronic back pain, psychological treatment may provide substantial and durable pain relief, according to a study published online September 29 in JAMA Psychiatry.

Yoni K. Ashar, PhD, from Weill Cornell Medical College in New York City, and colleagues conducted a trial with longitudinal functional magnetic resonance imaging (fMRI). Participants were randomly assigned to pain reprocessing therapy (PRT), aiming to shift patients’ beliefs about the causes and threat value of pain, placebo, or usual care.

At posttreatment, the researchers observed large group differences in pain, with mean pain scores of 1.18, 2.84, and 3.13 in the PRT, placebo, and usual care groups, respectively. For PRT vs placebo and usual care, Hedges g was −1.14 and −1.74, respectively. At posttreatment, 66% of patients randomly assigned to PRT were pain-free or nearly pain-free compared with 20 and 10% of those randomly assigned to placebo and usual care, respectively. At one-year follow-up, treatment effects were maintained, with a mean pain score of 1.51, 2.79, and 3.00 in the PRT, placebo, and usual care groups, respectively. In longitudinal fMRI, responses to evoked back pain in the anterior midcingulate and the anterior prefrontal cortex were reduced for PRT versus placebo and in the anterior insula for PRT vs usual care.

“This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain,” Asher said in a statement. “Our study shows it works.”

Several authors disclosed financial ties to the pain industry; two authors have written books on the subject of pain reprocessing therapy.

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