Author: Lori Uildriks
Medical News Today
- A recent study found that people with low-to-moderate chronic back pain who received pain-reprocessing therapy (PRT) experienced significant reductions in pain intensity after the treatment, with most individuals maintaining these reductions for 1 year.
- In all, 66% of participants receiving PRT were pain-free or nearly pain-free posttreatment.
- Scientists will need to do more research to assess how useful PRT may be in treating other forms of primary chronic pain.
According to the authors of the recent study, back pain is the most common type of chronic pain.
Most acute back pain, which lasts less than 4 weeks, typically improves in several days to a few monthsTrusted Source. Still, up to 33% of people may experience moderate intensity back pain 1 year later, with 20% having considerable physical limitations.
The authors explain that for 85% of people who experience chronic low back pain, there is no identifiable cause.
The American College of Physicians (ACP) issued clinical guidelines that strongly recommend the preferential use of nonpharmacological agents to treat chronic low back pain, which it defines as pain lasting more than 12 weeks. These therapies include:
- mindfulness stress reduction
- cognitive behavioral therapy
- tai chi
- progressive relaxation
For people who do not respond to these treatments, the ACP guidelines recommend nonsteroidal anti-inflammatory drugs in the first instance. If these do not work, doctors may try duloxetine, which is an antidepressive, or tramadol, which is an opioid.
However, the guidelines suggest that doctors should only use opioids when the potential benefits outweigh the risks.
Although these therapies may improve functioning for some people, others experience limited reductions in pain intensity.
These mixed responses have led researchers at the University of Colorado at Boulder to develop and test PRT as a potential treatment for chronic back pain. The study results appear in JAMA PsychiatryTrusted Source.
Dr. Yoni Ashar, Ph.D., the lead author of the study, explained to Medical News Today: “Many people believe, and are told by physicians and others, that pain is a sign of tissue injury. The belief is that every time you feel pain, it means that you’re damaging your back.”
Dr. Ashar added, “Brain sensitization occurs due to a vicious cycle: Pain induces fear (this is natural), which leads to hypervigilance and avoidance, which leads to more pain.”
After ruling out identifiable causes of chronic back pain, PRT involves exercises that aim to help people comprehend that the source of their pain is due not to injury but to altered brain pathways, which are modifiable.
Dr. Ashar explained how “guided meditations […] induce a shift from avoidance of bodily sensations to engaging with them with an attitude of curiosity and lightness, knowing that they are safe.”
The researchers conducted a randomized controlled study from August 2017 to November 2019. The participants were aged 21–70 years and based in Boulder, CO. All individuals reported experiencing back pain for at least half of the days in the last 6 months.
The participants received PRT, placebo, or just their usual care. Those in the PRT group initially received a 1-hour telehealth evaluation and education session with a doctor. They then underwent eight individual 1-hour PRT sessions with a therapist, which took place twice weekly for 4 weeks.
Those in the placebo group watched two videos discussing how placebo treatments contribute to the body’s healing response. They also received a saline injection at the site where the pain was most significant and continued ongoing care.
The researchers measured the 1-week mean back pain intensity score following treatment. They also used three methods to assess the participants’ pain beliefs and conducted functional MRI (fMRI) scansTrusted Source to measure responses to evoked pain and ongoing pain after resting.
The study analyzed data from 135 participants — 44 in the PRT group, 44 in the placebo group, and 47 in the usual care group.
At the start of the study, the participants had had chronic back pain for an average of 10 years, with an average pain intensity score of 4.10 out of 10. They had an average age of 41 years, and 54% were female.
The participants in the PRT group experienced a significant reduction in average pain scores compared with those in the placebo and usual care groups: a drop of 1.79 and 2.40 on the 0–10 scale, respectively.
In all, 66% of people in the PRT group, 20% in the placebo group, and 10% of the standard care group were pain-free or nearly pain-free after treatment.
Average pain scores at the 1-year follow-up were 1.51 in the PRT group, 2.79 in the placebo group, and 3.00 in the usual care group.
Dr. Ilan Danan is a sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. He was not involved in the study but spoke with MNT.
Dr. Danan said that he found the results “reassuring.” He explained how “patients oftentimes won’t look toward nonpharmacological […] means of addressing pain, especially in a chronic pain scenario.”
He added, “So to find ongoing evidence through these studies […] to support the use of nonpharmaceutical means of addressing chronic pain, […], we ought to pursue it as clinicians and address it with our patients.”
The study has many strengths. For instance, it used a randomized, controlled design with active and placebo control groups and employed fMRI as an objective measure to correlate treatment effects with validated pain scores.
However, the participants were predominantly white and well-educated with low-to-moderate pain and disability at baseline, which limits the generalizability of the findings.
Scientists will need to carry out more studies to evaluate the usefulness of PRT for the treatment of other types of chronic pain.
Dr. Ashar commented: “The pain is always 100% real. The key to successful treatment is understanding what is causing the pain — in some cases, the causes are complex, [but] in other cases, the pain is due primarily to changes in brain pathways.”
He added, although “PRT is not appropriate [to treat] pain secondary to an acute injury or inflammation, […] we are hoping our work will help shift the paradigm. Combined psychological and behavioral treatments can eliminate or greatly reduce pain in a substantial portion of chronic pain patients.”