- A recent study found that patients with mild to moderate chronic back pain who received pain reprocessing therapy (PRT) had significantly reduced pain intensity after treatment, and most people maintained these reductions for 1 year.
- In total, 66% of participants receiving PRT were painless or almost painless after treatment.
- Scientists need to do more research to evaluate the role of PRT in treating other forms of primary chronic pain.
According to the authors of a recent study, back pain is the most common type of chronic pain.
Most acute back pains last less than 4 weeks and usually get better within a few days to a few months. still,
The author explains that for 85% of people with chronic low back pain, there is no identifiable cause.
The clinical guidelines issued by the American College of Physicians (ACP) strongly recommend the use of non-pharmaceuticals for the treatment of chronic low back pain, which is defined as pain lasting more than 12 weeks. These treatments include:
For people who do not respond to these treatments, the ACP guidelines first recommend the use of non-steroidal anti-inflammatory drugs. If none of these work, doctors may try the antidepressant duloxetine or the opioid tramadol.
However, the guidelines recommend that doctors use opioids only when the potential benefits outweigh the risks.
Although these therapies may improve the function of some people, others have limited pain intensity reduction.
These diverse responses prompted researchers at the University of Colorado at Boulder to develop and test PRT as a potential treatment for chronic back pain.Research results appear in
The lead author of the study, Dr. Yoni Ashar, explained Medical news today: “Many people believe and are told by doctors and others that pain is a sign of tissue damage. People believe that whenever you feel pain, it means your back is hurt.”
Dr. Ashar added: “Brain sensitivity occurs due to a vicious circle: pain causes fear (which is natural), which leads to excessive alertness and avoidance, which leads to more pain.”
After excluding the identifiable causes of chronic back pain, the exercises involved in PRT are designed to help people understand that the source of pain is not due to injury, but due to changes in brain pathways, which can be modified.
Dr. Ashar explained how to “guide meditation […] Inducing changes from avoiding physical sensations to approaching them with curiosity and ease, knowing that they are safe. “
Researchers conducted a randomized controlled study from August 2017 to November 2019. Participants were between 21-70 years old and lived in Boulder, Colorado. All participants reported back pain at least half of the time in the past 6 months.
Participants received PRT, placebo or just their usual care. People in the PRT group initially received 1 hour of telemedicine evaluation and education with the doctor. They then conducted eight separate 1-hour PRT sessions with the therapist, twice a week for 4 weeks.
People in the placebo group watched two videos discussing how placebo treatment promotes the body’s healing response. They also injected saline into the most painful areas and continued nursing.
The researchers measured the average back pain intensity score 1 week after treatment.They also used three methods to assess participants’ pain beliefs and performed
The study analyzed data from 135 participants—44 in the PRT group, 44 in the placebo group, and 47 in the routine care group.
At the beginning of the study, participants had chronic back pain for an average of 10 years, with an average pain intensity score of 4.10 (out of 10 points). Their average age is 41 and 54% are women.
Compared with the placebo group and the routine care group, the average pain score of the participants in the PRT group was significantly lower: 0-10 points decreased by 1.79 and 2.40, respectively.
A total of 66% of the PRT group, 20% of the placebo group, and 10% of the standard care group were painless or almost painless after treatment.
At the 1-year follow-up, the average pain score was 1.51 in the PRT group, 2.79 in the placebo group, and 3.00 in the routine care group.
Dr. Ilan Danan is a motor neurologist and pain management expert at the Center for Motor Neurology and Pain Medicine at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles.He was not involved in this research, but with MNT.
Dr. Danan said that he found the results “reassuring.” He explained that “patients usually don’t see non-drug treatments” […] The solution to pain, especially in chronic pain situations. “
He added, “So we need to find consistent evidence through these studies […] Support the use of non-medicinal means to solve chronic pain, […]As clinicians, we should pursue it and resolve it with our patients. “
This research has many advantages. For example, it uses a randomized, controlled design that includes active and placebo controls, and uses fMRI as an objective measure to correlate treatment effects with validated pain scores.
However, the participants were mainly white, well-educated, and had moderate pain and disability at baseline, which limited the generality of the findings.
Scientists need to conduct more research to evaluate the effectiveness of PRT in treating other types of chronic pain.
Dr. Ashar commented: “Pain is always 100% real. The key to successful treatment is to understand the cause of pain-in some cases, the cause is complex. [but] In other cases, the pain is mainly due to changes in brain pathways. “
He added that although “PRT is not suitable [to treat] Pain secondary to acute injury or inflammation, […] We hope that our work will help shift the paradigm. Combining psychological and behavioral therapy can eliminate or greatly reduce the pain of most chronic pain patients. “