Patients with back pain without a specific underlying cause may benefit from therapy that teaches them to rethink pain, a new study suggests.
Researchers found that a significant proportion of patients with chronic back pain were able to remain pain free for a year after taking a specific type of treatment.
The patients received Pain Reprocessing Therapy (PRT), which aims to help people understand that their pain is due to mind-brain processes rather than bodily injury.
The researchers said the therapy can help a patient “reframe pain as a ‘false alarm’ of danger.”
The idea is that by thinking of pain as harmless rather than threatening, patients can change the pain-enhancing brain networks and neutralize it.
The authors of the new study said that PRT and associated treatments that combine psychological and behavioral approaches may be helpful for “many, if not most” of patients with chronic back pain.
But they pointed out that patients with specific causes of pain such as sciatica might not benefit.
The new study, published in the journal Jama Psychiatry, looked at data from 151 adults with an average age of 41 with mild to moderate pain who had been in pain for an average of 10 years.
The team of US-based researchers used follow-up scans and evaluations to check whether or not the therapy was helping patients.
One group received an appointment with a doctor followed by eight PRT sessions over four weeks.
Another group received a dummy drug as an injection and a final group received standard care.
They found that after one year, 66% of people in the PRT group were “pain free,” compared to 20% in the placebo group and 10% who received usual care.
“For a long time, we thought that chronic pain was primarily due to bodily issues, and most treatments to date have targeted that,” said lead author Yoni Ashar, University of Colorado Boulder.
“This treatment is based on the principle that the brain can generate pain in the absence of an injury or after an injury has healed, and that people can unlearn that pain. Our study shows that it works.
The authors explained that about 85% of chronic back pain has no known cause, such as injury or illness – sometimes referred to as primary chronic pain.
It has been suggested that “failed neural pathways” are at least partially to blame.
Studies have already shown that different areas of the brain, including those associated with reward and fear, activate more during episodes of chronic pain than during acute pain.
Dr Ashar said that if pain is a warning signal that something is wrong with the body, primary chronic pain is “like a false alarm stuck in the ‘on’ position.”
“The idea is that by thinking of pain as harmless rather than threatening, patients can alter the pain-enhancing brain networks and neutralize it.”
Before and after treatment, participants underwent an MRI to measure their brain’s response to a mild painful stimulus.
And when people in the PRT group were exposed to pain in the CT scan after treatment, areas of the brain associated with the pain treatment “calmed down significantly,” the authors added.
The article concludes: “Psychological treatment focused on changing patient beliefs about the causes and threat value of pain can provide substantial and lasting pain relief in chronic back pain.”
Earlier this year, the National Institute for Health and Care Excellence (Nice) recommended that people with chronic primary pain be offered a range of treatments to help them manage their condition.
These may include exercise programs and psychological therapy CBT and Acceptance and Commitment Therapy (ACT). Acupuncture is also recommended as an option for some.
Nice said people with chronic primary pain should not be offered pain relievers such as paracetamol, nonsteroidal anti-inflammatory drugs, benzodiazepines or opioids.
“This is because, although there is little to no evidence that they make a difference to people’s quality of life, pain, or psychological distress, they can cause harm, including possible addiction. “Nice said in a statement.
Its guideline recommends that an antidepressant may be considered for some patients.
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