Back pain: Psychological treatment shown to yield strong, lasting pain
relief, alter brain networks
Two thirds of patients found relief; benefits lasted one year

Date:
September 29, 2021
Source:
University of Colorado at Boulder
Summary:
A study of chronic back pain patients finds that more than
two-thirds of those who underwent a novel, 4-week psychological
treatment were pain- free or nearly pain-free afterward. Those
in the treatment group also saw brain regions involved in pain
processing quiet. For many, the benefits lasted at least one year.



FULL STORY ========================================================================== Rethinking what causes pain and how great of a threat it is can provide
chronic pain patients with lasting relief and alter brain networks
associated with 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 underwent a four-week psychological
treatment called Pain Reprocessing Therapy (PRT) were pain-free or nearly pain-free post- treatment. And most maintained relief for one year.

The findings provide some of the strongest evidence yet that
a psychological treatment can provide potent and durable relief for
chronic pain, which afflicts one in five Americans.

"For a long time we have thought that chronic pain is due primarily to
problems in the body, and most treatments to date have targeted that,"
said lead author Yoni Ashar, who conducted the study while earning his
PhD in the Department of Psychology and Neuroscience at CU Boulder. "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. Our study shows it works." Misfiring neural pathways Approximately 85% of people with chronic back pain have what is known
as "primary pain," meaning tests are unable to identify a clear bodily
source, such as tissue damage.



========================================================================== Misfiring neural pathways are at least partially to blame: Different
brain regions -- including those associated with reward and fear --
activate more during episodes of chronic pain than acute pain, studies
show. And among chronic pain patients, certain neural networks are
sensitized to overreact to even mild stimuli.

If pain is a warning signal that something is wrong with the body,
primary chronic pain, Ashar said, is "like a false alarm stuck in the
'on' position." PRT seeks to turn off the alarm.

"The idea is that by thinking about the pain as safe rather than
threatening, patients can alter the brain networks reinforcing 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 least four on a scale of zero
to 10.



========================================================================== Those in the treatment group completed an assessment followed by eight
one-hour sessions of PRT, a technique developed by Los Angeles-based
pain psychologist Alan Gordon. The goal: To educate the patient about
the role of the brain in generating chronic pain; to help them reappraise
their pain as they engage in movements they'd been afraid to do; and to
help them address emotions that may exacerbate their pain.

Pain is not 'all in your head' "This isn't suggesting that your pain
is not real or that it's 'all in your head'," stressed Wager, noting
that changes to neural pathways in the brain can linger long after
an injury is gone, reinforced by such associations. "What it means is
that if the causes are in the brain, the solutions may be there, too."
Before and after treatment, participants also underwent functional
magnetic resonance imaging (fMRI) scans to measure how their brains
reacted to a mild pain stimulus.

After treatment, 66% of patients in the treatment group were pain-free or nearly pain-free compared to 20% of the placebo group and 10% of the no- treatment group.

"The magnitude and durability of pain reductions we saw are very rarely observed in chronic pain treatment trials," Ashar said, noting that
opioids have yielded only moderate and short-term relief in many trials.

And when people in the PRT group were exposed to pain in the scanner post- treatment, brain regions associated with pain processing -- including the anterior insula and anterior midcingulate -- had quieted significantly.

The authors stress that the treatment is not intended for "secondary pain"
- - that rooted in acute injury or disease.

The study focused specifically on PRT for chronic back pain, so future,
larger studies are needed to determine if it would yeild similar results
for other types of chronic pain.

Meanwhile, other similar brain-centered techniques are already emerging
among physical therapists and other clinicians who treat pain.

"This study suggests a fundamentally new way to think about both the
causes of chronic back pain for many people and the tools that are
available to treat that pain," said co-author Sona Dimidjian, professor
of psychology and neuroscience and director of the Renee Crown Wellness Institute at CU Boulder.

" It provides a potentially powerful option for
people who want to live free or nearly free of pain." ========================================================================== Story Source: Materials provided by
University_of_Colorado_at_Boulder. Original written by Lisa
Marshall. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Yoni K. Ashar et al. Effect of Pain Reprocessing Therapy vs
Placebo and
Usual Care for Patients With Chronic Back Pain: A Randomized
Clinical Trial. JAMA Psychiatry Original Investigation, September
29, 2021 DOI: 10.1001/jamapsychiatry.2021.2669 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/09/210929112846.htm

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