Doctor, I have chronic back pain. Could Pain Reprocessing Therapy help reduce my pain?

Pain Reprocessing Therapy (PRT), a psychological treatment designed to help people change how they understand and respond to pain led to significant pain relief for people with primary chronic back pain (CBP), a type of back pain with no clear physical cause. These benefits lasted for at least one year.

What is the evidence?

SUMMARY OF FINDINGS

Pain Reprocessing Therapy (PRT) vs Placebo vs Usual Care

Outcome	Group	Baseline	After treatment	Effect
Pain intensity (0-10 scale) at one week*	PRT Placebo Usual Care	4.22 4.16 3.91	1.18 2.84 3.13	PRT reduced pain by a large amount compared to people who had placebo or usual treatment
Pain-free or nearly pain-free at four weeks**	PRT Placebo Usual Care	0% 0% 0%	66% 20% 10%	More people who had PRT were pain-free or nearly pain-free compared to people who had placebo or usual treatment
Sustained pain relief at one year***	PRT Placebo Usual Care	4.22 4.16 3.91	1.51 2.79 3.00	People who had PRT had less pain than people who had placebo or usual care one-year after treatment

Outcome

Group

Baseline

After treatment

Effect

Pain intensity (0-10 scale) at one week*

PRT

Placebo

Usual Care

4.22

4.16

3.91

1.18

2.84

3.13

PRT reduced pain by a large amount compared to people who had placebo or usual treatment

Pain-free or nearly pain-free at four weeks**

PRT

Placebo

Usual Care

66%

20%

10%

More people who had PRT were pain-free or nearly pain-free compared to people who had placebo or usual treatment

Sustained pain relief at one year***

PRT

Placebo

Usual Care

4.22

4.16

3.91

1.51

2.79

3.00

People who had PRT had less pain than people who had placebo or usual care one-year after treatment

Notes:

*Pain intensity was measured using a 0-10 numerical rating scale (0 = no pain, 10 = worst pain imaginable).

**Scores reported are the group averages at specific time points (post-treatment and 1-year follow-up).

***Sustained pain relief indicates long-term effects assessed 1 year after treatment completion.

What kind of study was this?

This was a randomized controlled trial (RCT).

Who? The study included 151 adults with primary chronic back pain (no clear physical cause) for an average of 10 years. Participants were aged 21–70 (average age: 41 years), with pain scores of 4 out of 10 or higher. Of the participants, 54% were women, and 46% were men. Participants were randomly assigned as follows: 50 participants in the PRT group, 51 participants in the placebo group, and 50 participants in the usual care group.

What? This trial compared Pain Reprocessing Therapy (PRT) with placebo and with usual care.

Treatment	vs	Placebo and Usual care
Pain Reprocessing Therapy (PRT): Participants had one telehealth session with a physician and 8 therapy sessions over 4 weeks. Therapy focused on reframing pain as a harmless signal from the brain using cognitive, somatic, and exposure-based techniques.		Placebo: Participants received saline (water) injections along with education about placebo effects. They continued their usual care. Usual care: Participants continued their routine care without any additional interventions.

Treatment

Placebo and Usual care

Pain Reprocessing Therapy (PRT): Participants had one telehealth session with a physician and 8 therapy sessions over 4 weeks. Therapy focused on reframing pain as a harmless signal from the brain using cognitive, somatic, and exposure-based techniques.

Placebo: Participants received saline (water) injections along with education about placebo effects. They continued their usual care.

Usual care: Participants continued their routine care without any additional interventions.

Why was this research done?

Chronic back pain is common and often hard to treat, especially when there is no known physical cause. Many treatments, like medications, do not provide lasting relief. This study explored whether a psychological treatment, Pain Reprocessing Therapy (PRT), could help by changing how people think about and react to their pain. The researchers found that PRT provided pain relief that was long-lasting for many participants, but the results may not apply to everyone. The study specifically focused on primary chronic back pain (CBP). More research is needed to determine if PRT works for people with different backgrounds and lifestyles.

This Evidence Summary is based on the following article:

Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022 Jan 1;79(1):13-23. doi: 10.1001/jamapsychiatry.2021.2669. PubMed

Published: Friday, December 20, 2024

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2024/12/21.

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