Rethinking what causes pain and how great of a threat it poses can provide chronic pain patients with long-lasting relief and alter brain networks involved in pain processing According to new University of Colorado Boulder-led research.
The study, published Sept. 29 in JAMA Psychiatry, found that two-thirds of chronic back pain patients who received a four-week psychotherapeutic treatment known as Pain Reprocessing Therapy (PRT) were pain-free or near pain-free after treatment. The majority of patients reported relief for at least one year.
These findings are the strongest evidence yet that psychological treatment can offer lasting relief to chronic pain. It is an illness that affects a fifth of Americans.
Yoni Ashar, a lead author of the study, said chronic pain has been attributed to problems in the body for a long time. The study was conducted while working on his PhD at the CU Boulder’s Department of Psychology and Neuroscience. “This treatment is based upon the notion that the brain can cause pain even though there is no injury or an injury has healed. People can also learn to stop causing pain. It is effective, as per our research.
Misfiring neural pathways
About 85% of those suffering from chronic back pain suffer from what’s known as “primary pain.” This means that tests are not in a position to pinpoint a specific cause of the pain such as damage to the tissue.
Neuronal pathways that are not firing correctly are at least partially responsible Different brain regions – including those that are associated with reward and fear-;activate more when there is chronic pain than acute pain, research studies show. Chronic pain sufferers are more sensitive to minor stimuli than others, and some neural networks are hypersensitive to them.
If pain signals that something is not right within the body, the chronic pain, Ashar said it is “like an alarm that has been triggered in the ‘on’ position.”
PRT is designed to reduce the alarm.
“The theory is that by imagining the pain as safe rather than threatening patients can alter neural networks that are responsible for causing the pain, and neutralize it,” said Ashar, now a postdoctoral researcher at Weill Cornell Medicine.
For the randomized controlled trial, Ashar and senior author Tor Wager, now the Diana L. Taylor Distinguished Professor in Neuroscience at Dartmouth College, recruited 151 men and women who had back pain for at least six months at an intensity of at minimum four on a scale from zero to 10.
The test was followed by eight one-hour sessions (PRT) by Alan Gordon, a Los Angeles-based pain psychologist from Los Angeles. The aim was to educate the patient about the function of the brain in generating chronic pain; to help them understand their pain when they engage in activities they’ve not thought of doing and to help them address emotions that may exacerbate their pain.
The pain isn’t all in your head.
Wager said that this doesn’t mean that the pain isn’t real or that it’s all in your head. He also pointed out that brain changes can persist even after an injury is repaired. This is bolstered by these connections. “What it means is that if the root causes are in the brain, then the solutions could be there too.”
Participants also had functional magnetic resonance imaging (fMRI) scans that were taken prior to and after treatment to determine how their brains responded to mild pain stimuli.
66% of patients who received treatment had pain relief or near-pain relief after treatment, as compared to 20% in the placebo group and 10% in the no-treatment group.
“The magnitude and durability of the pain reductions we observed are rarely seen in chronic trials for pain treatment,” Ashar said, noting that opioids have provided only moderate and short-term relief in a number of trials.
And when people in the PRT group were subjected to discomfort in the scanner following treatment the brain regions involved in pain processing, including the anterior insula and the anterior midcingulate – had slowed down significantly.
The authors emphasize that the treatment does not target “secondary pain” that is caused by acute injury or illness.
The study was focused on the use of PRT to treat chronic back pain. The next study will be more extensive to determine if similar results can be achieved for other types chronic pain.
While other brain-centered techniques are already ememrging among physical therapists and other practitioners who treat pain.
This study provides a new way to think about the causes of chronic back pain for many people and the tools available to treat the pain. It offers a potentially effective option for people who want to live free or nearly free of pain.”
Sona Dimidjian is co-authorand professor of neuroscience and psychology and director of the Renee Crown Wellness Institute at CU Boulder
Ashar, Y.K., and others. (2021) Effect of Pain Reprocessing Therapy vs Placebo and Usual Treatment for Patients With Chronic Back Pain : A Randomized Clinical Study. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2021.2669.
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