Pain processing therapy reduces pain perception, disability for chronic back pain

In people with chronic back pain, a randomized clinical trial found that psychological intervention that focuses on changing patients’ beliefs about their pain can provide significant pain relief. These results were published in JAMA Psychiatry.

Individuals (N = 151) with chronic back pain were recruited from the Boulder, Colorado community between 2017 and 2020. Participants were randomly assigned to normal treatment (n = 50), placebo (n = 51), or pain management therapy (n = 50). Clinical and functional magnetic resonance imaging assessments were completed at baseline and after a 1-year follow-up.

The pain management therapy intervention consisted of 8 individual, one-hour therapy sessions over 4 weeks that focused on providing evidence of pain, guiding pain management, techniques for coping with psychosocial threats, and strategies for increasing positive emotions. The open label placebo cohort watched 2 instructional videos on the placebo effect and received a subcutaneous injection of saline at the site of the back pain.

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More than half of the participants (54%) were women; Mean age 41.1 (standard deviation [SD], 1.26) years, the duration of chronic back pain was 10.0 (SD, 8.9) years, the pain intensity ranged from 4.10 (SD, 1.26) to 4.41 (SD, 1.29) and the mean Oswestry Disability Index (ODI) was 23.34 (SD, 1.26) 10.12).

The intervention for pain management therapy was completed by 88% of the participants, the placebo arm by 86% of the patients and the intervention for normal care by 94% of the participants.

At the 12-month follow-up, patients in the pain management therapy group reported less pain in the previous week than recipients of either of the two usual treatments (g, -1.05; standard error [SE], 0.24; P <0.001) or placebo (g, -0.70; SE, 0.21; P = 0.001).

In addition, the intervention for pain management showed a greater improvement in scores for 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 to usual treatment. Group differences between placebo and pain therapy were only observed in the ODI scores (P <.001), but not in any of the PROMIS indices (all P ³.272).

The neuroimaging assays showed that spontaneous pain decreased after treatment in the pain management therapy group compared to usual treatment (b, -21.53; P <0.001) and placebo (b, -18.24; P <0.001) was. Similar patterns were observed in evoked back pain compared to usual treatment (b, -19.61; p <0.001) and placebo (b, -13.05; p = 0.006).

In the pain management therapy group, the reduction in one-week pain correlated with evoked pain (r, 0.47; P = 0.005).

During evoked pain, recipients of pain management therapy intervention showed reduced activity in the left anterior islet (t[120.1], -2.34; P = .01) compared to normal care recipients and in the anterior middle cingulate area (t[133.48], -1.73; P = .04) and anterior prefrontal cortex (t[133.48], -1.85; P = .03) compared to the placebo cohort.

This study was possibly power limited as some significant functional results did not survive whole brain corrections.

These data suggested that pain relief therapy intervention may enable people with chronic low back pain to manage their pain-related symptoms more effectively.

Disclosure: Several authors stated links to industry. For a full list of the details, see the original article.


Ashar YK, Gordon A, Schubiner H, et al. Effect of pain management therapy versus placebo and usual treatment in patients with chronic back pain: a randomized clinical trial. JAMA psychiatry. Published online 29 September 2021. doi: 10.1001 / jamapsychiatry.2021.2669

This article originally appeared on Psychiatry Advisor

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