According to new research led by the University of Colorado at Boulder, rethinking the causes of pain and how threatening it is can provide chronic pain patients with lasting relief and change the brain network related to pain processing.
The research was published on September 29 in JAMA Psychiatry, It was found that two-thirds of patients with chronic back pain who received a 4-week psychotherapy called Pain Reprocessing Therapy (PRT) were painless or almost painless after treatment. Most people maintained relief for a year.
These findings provide the strongest evidence to date, showing that psychotherapy can effectively and lastingly relieve chronic pain, which afflicts one in five Americans.
“For a long time, we have always believed that chronic pain is mainly caused by physical problems, and most of the treatments so far have been directed at this,” said lead author Yoni Ashar, who did this while earning his PhD in psychology. Studies. Neuroscience at CU Boulder. “The premise of this treatment is that the brain can produce pain after no injury or healing, and people can forget the pain. Our research shows that it is effective.”
Wrong neural pathway
Approximately 85% of patients with chronic back pain suffer from so-called “primary pain”, which means that the test cannot determine a clear physical source, such as tissue damage.
The failure of neural pathways is at least partly responsible: Research shows that different brain regions—including those associated with reward and fear—are more active during chronic pain episodes than acute pain. In patients with chronic pain, certain neural networks overreact to even mild stimuli.
Ashar said, if pain is a warning sign of a physical problem, then primary chronic pain “is like a false alarm, staying in the’on’ position.”
The PRT tried to turn off the alarm.
“The idea is that by treating pain as a safety rather than a threat, patients can change the brain network that strengthens pain and neutralize it,” said Ashar, who is now a postdoctoral researcher in Weill Cornell’s medicine.
In a randomized controlled trial, Ashar and senior author Tor Wager, now the Diana L. Taylor Distinguished Professor of Neuroscience at Dartmouth College, recruited 151 men and women with back pain for at least 6 months. Their The intensity of back pain should be at least 4 months. The range is from 0 to 10.
People in the treatment group completed an assessment and then underwent eight one-hour PRTs, a technique developed by Los Angeles pain psychologist Alan Gordon. Goal: To educate patients on the role of the brain in producing chronic pain; to help them reassess their pain when doing actions they are afraid to do; and to help them deal with emotions that may exacerbate pain.
Pain is not “all in your mind”
“This is not to say that your pain is not real, or that it is’all in your mind’,” Wagg emphasized, noting that changes in the brain’s nerve pathways may last a long time after the injury disappears. This association Will strengthen. “This means that if the cause is in the brain, then the solution may also be there.”
Before and after treatment, participants also received functional magnetic resonance imaging (fMRI) scans to measure their brain’s response to mild painful stimuli.
After treatment, 66% of patients in the treatment group were painless or almost painless, compared with 20% in the placebo group and 10% in the non-treatment group.
“We rarely observe the magnitude and persistence of pain reduction in chronic pain treatment trials,” Achar said, noting that opioids can only produce moderate and short-term relief in many trials.
When people in the PRT group were exposed to pain in the post-treatment scanner, the brain areas related to pain processing—including the forebrain insula and the anterior-middle cingulate gyrus—have quieted down significantly.
The author emphasizes that this treatment is not suitable for “secondary pain”-that is, due to acute injury or disease.
The study specifically targets PRT for chronic back pain, so larger studies are needed in the future to determine whether it will produce similar results for other types of chronic pain.
At the same time, other similar brain-centric technologies have emerged among physiotherapists and other clinicians who treat pain.
This study proposes a new way to think about the causes of chronic back pain in many people and the tools that can be used to treat this pain. It provides a potentially powerful option for people who want freedom or almost no pain. “
Sona Dimidjian, co-author, professor of psychology and neuroscience, director of CU Boulder Renee Crown Wellness Institute
University of Colorado Boulder
Ashar, YK, Wait. (2021) A randomized clinical trial of the effects of pain reprocessing therapy, placebo and conventional care on patients with chronic back pain. JAMA Psychiatry. doi.org/10.1001/jamapsychiatry.2021.2669.