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Retraining the Brain May Eliminate Chronic Back Pain
Psychological therapy that changes an individual’s beliefs about pain not only provides lasting chronic pain relief but also alters brain regions related to pain generation, new research shows.
In the first randomized controlled test of pain reprocessing therapy (PRT), two thirds of patients with chronic back pain (CBP) who received 4 weeks of PRT were pain free or nearly pain free afterward ― and for most patients, relief was maintained for 1 year, the researchers found.
“Primary chronic back pain can be dramatically reduced or even eliminated by psychological treatment focused on changing how threatening we perceive the pain to be,” first author Yoni Ashar, PhD, Department of Psychiatry, Weill Cornell Medical College, New York City, told Medscape Medical News.
“We were very surprised” by the impact, Ashar admitted, given that large reductions in pain have rarely been observed in studies that tested psychological therapies for chronic back pain.
The study was published online September 29 in JAMA Psychiatry.
Commenting on the findings for Medscape Medical News, Shaheen E. Lakhan, MD, PhD, neurologist and pain specialist in Newton, Massachusetts, said he has long experience using psychological approaches to address pain, with good results.
“Imagine telling a person suffering from decades of chronic pain that your pain is all in your head. I’ve done that for years as a board-certified pain physician managing only the most severe and debilitating forms of pain. When used to ground brain retraining, I could ultimately restore function to people living with chronic pain,” Lakhan said.
“The statement is true ― the brain ultimately processes signals from throughout the body, forms the perception of pain, and links it to emotional brain centers, among others. Pain is an important survival mechanism so that when your body is at threat of injury, you protect yourself from further damage and withdraw. The problem lies when pain outlasts its welcome and chronifies,” said Lakhan, senior vice president of research and development, Click Therapeutics, in Boston, Massachusetts.
The investigators in this study “eloquently prove” that with 4 weeks of PRT, patients can learn that chronic pain is largely a “brain-generated false alarm and that constantly affirming this truth can actually reduce or eliminate it,” Lakhan said.
“Further, the brain areas implicated with pain are calmed after going through the therapy to both resting pain and pain induced by extending the back,” he noted.
“Pain reprocessing therapy can improve the lives of chronic [pain patients] who have low to moderate levels of pain and disability; however, much work needs to be done to make this scalable and universally available and covered by insurers as a treatment modality,” Lakhan added.
He cautioned that he has not seen therapies such as this work when there is significant depression, withdrawal, or lack of control over one’s situation such that one behaves in a helpless manner ― “a terrible state of mind called learned helplessness.”
JAMA Psychiatry. Published online September 29, 2021. Full text
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