For people with chronic back pain, a randomized clinical trial found that a psychological intervention focused on changing patients’ beliefs about their pain may result in substantial pain relief. These findings were published in JAMA Psychiatry.
Individuals (N=151) with chronic back pain were recruited from the community in Boulder, Colorado, between 2017 and 2020. Participants were randomly assigned to receive usual care (n=50), placebo (n=51), or pain reprocessing therapy (n=50). Clinical and functional magnetic resonance imaging assessments were completed at baseline and after a 1-year follow-up.
The pain reprocessing therapy intervention consisted of 8 individual, 1-hour therapy sessions over 4 weeks that focused on providing evidence for pain, guiding reappraisal of pain, techniques for coping with psychosocial threats, and strategies to increase positive emotions. The open-label placebo cohort watched 2 educational videos about the placebo effect and received a subcutaneous saline injection at the site of back pain.
More than half of the participants (54%) were women; mean age was 41.1 (standard deviation [SD], 1.26) years, duration of chronic back pain was 10.0 (SD, 8.9) years, pain intensity ranged from 4.10 (SD, 1.26) to 4.41 (SD, 1.29), and average Oswestry Disability Index (ODI) was 23.34 (SD, 10.12).
The pain reprocessing therapy intervention was completed by 88% of participants, the placebo arm by 86% of patients, and the usual care intervention by 94% of participants.
At the 12-month follow-up, patients in the pain reprocessing therapy group reported less pain during the previous week than recipients of either usual care (g, -1.05; standard error [SE], 0.24; P <.001) or placebo (g, -0.70; SE, 0.21; P =.001).
In addition, the pain reprocessing therapy intervention was associated with greater improvement in scores on ODI (P <.001), Patient-Reported Outcome Measurement Information System (PROMIS) for depression (P =.007), PROMIS for anger (P =.008), PROMIS for anxiety (P =.014), and PROMIS for sleep (P =.009) compared with usual care. Group differences between placebo and pain reprocessing therapy were only observed for ODI scores (P <.001) but not any of the PROMIS indices (all P ³.272).
The neuroimaging assays found that spontaneous pain was decreased following treatment among the pain reprocessing therapy group compared with usual care (b, -21.53; P <.001) and placebo (b, -18.24; P <.001). Similar patterns were observed with evoked back pain compared with usual care (b, -19.61; P <.001) and placebo (b, -13.05; P =.006).
Among the pain reprocessing therapy group, reduction in 1-week pain was correlated with evoked pain (r, 0.47; P =.005).
During evoked pain, recipients of the pain reprocessing therapy intervention demonstrated reduced activity in the left anterior insula (t[120.1], -2.34; P =.01) compared with usual care recipients and in the anterior mid cingulate (t[133.48], -1.73; P =.04) and anterior prefrontal cortex (t[133.48], -1.85; P =.03) compared with the placebo cohort.
This study may have been limited by power as some significant functional results did not survive whole-brain corrections.
These data indicated that a pain reprocessing therapy intervention may allow individuals with chronic low back pain to cope more effectively with their pain-related symptoms.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
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. Published online September 29, 2021. doi:10.1001/jamapsychiatry.2021.2669