Google how to treat chronic back pain and countless results pop up. In fact, the options never seem to end. There’s acupuncture and massage, physical therapy and surgery, epidurals, and opioids. And on and on it goes.
Maybe you’re like the rest of us, and you’ve already tried a number of these alternatives only to be disappointed. Well, you’re not alone. According to the American Chiropractic Association, around 80% of people experience back pain during their lives (1). While sometimes this discomfort is temporary (also known as acute or lasting less than six months), other times the pain extends beyond the six-month mark and becomes chronic.
Finally, there’s hope in the form of Pain Reprocessing Therapy (PRT). A psychological treatment, PRT aims to change how patients view pain and what causes it. When someone feels pain for a prolonged period, neural pathways form in the brain around these sensations that then need to be turned off or desensitized (2). A recent study found that patients with chronic back pain responded extremely well to sessions of PRT, many of them overcoming their pain long term.
This article will explore PRT and its effectiveness as a long-lasting treatment for chronic back pain. It will also examine the aforementioned study to determine if its findings can benefit us.
What Is Pain Reprocessing Therapy?
Developed by Alan Gordon, LCSW of the Pain Psychology Center in Los Angeles, CA (3), Pain Reprocessing Therapy (PRT) is a groundbreaking new way to treat chronic pain. It focuses on the power of the brain-body connection and is based on the premise that pain is created and/or made worse by established neural pathways in the brain.
Put another way, when the body experiences a structural injury (like a cut, burn, or broken arm), the brain carries the sensation of pain along newly created neural pathways. As pain moves beyond the acute stage and becomes chronic, however, even though the structural wound may have healed, the neural pain pathways remain intact and may even become strengthened and habitual. This resulting pain is called neuroplastic pain.
It’s important to note that even though this pain is caused by the brain rather than a bodily injury, it is still very, very real. Anyone experiencing neuroplastic pain is feeling significant discomfort and isn’t making it up.
How Do You Know If You Have Neuroplastic Pain?
After confirming that the pain is not or is no longer caused by a structural issue (like a tumor, sprain, fracture, infection, etc.), the doctor will look to see if you meet specific criteria. The more items you identify with, the greater the chance your pain will be categorized as neuroplastic. If so, the next step is to essentially retrain the brain to lessen the sensitivity of the neural pain pathways that have formed.
Here’s a list of the criteria:
- You don’t have a structural injury.
- You have a background of multiple symptoms.
- Stress can trigger your pain.
- Your pain varies in its intensity.
- Your pain changes locations.
- You have a history of trauma.
- You tend to feel anxious and exhibit signs of perfectionism.
The more of these criteria that apply to you, the more likely your pain is neuroplastic instead of nociceptive (pain that is caused by damage to the body).
What Did The Study Find?
Published in JAMA Psychiatry, the main takeaway of the study, “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain,” was that using PRT physicians were able to successfully change the beliefs many patients had about pain and its causes, which eventually led to the alleviation of their chronic back pain.
The stats are pretty amazing. Of the 50 participants in the study who received four weeks of PRT, 33 of them (or 66%) had either no pain or very little pain after they had completed their treatment (4). And, a year later, the study found that most of them were still without pain.
In comparison, only 20% of participants who received placebos (10 out of 51) and 10% of the participants that used usual care methods (5 out of 50) were similarly freed from their pain.
The patients who received PRT saw a physician once via a telehealth session and a therapist eight times in person over four weeks. During these sessions they were taught to reframe their pain as something that wasn’t dangerous, threatening, or related to bodily harm. Moreover, participants were taught ways to deal with emotions that might trigger symptoms and to be more compassionate and loving towards themselves.
Functional MRIs were also conducted repeatedly, over time, on the study participants. The results showed that patients who received PRT had less prefrontal brain responses to evoked back pain and more resting prefrontal-somatosensory connectivity than participants who were given placebos or usual care.
How Do You Combat Neuroplastic Pain?
As the study found, using PRT to change one’s beliefs and expectations of pain can be effective in significantly alleviating chronic pain over the long term. Exactly what happens during these therapy sessions? The primary technique used in PRT is called somatic tracking.
This method encourages the participant to be aware of when pain is occurring (mindfulness) and then to reframe that pain as harmless or safe. It also teaches the patient to generate positive feelings at the same time. The idea is to replace fear with a sense of safety, which allows the brain to reprocess these sensations as non-dangerous. Eventually, as simple as it sounds, the pain will go away.
For more information about PRT and other mind-body therapies that can help reduce chronic back pain, please visit this earlier Lin blog post.
A Final Word From Lin
We’re only beginning to realize the full power and potential of our brains in relation to pain. But what we’ve learned so far is encouraging for everyone: in many cases, it is possible to teach your brain to think differently about pain. And then when you no longer fear it, you can dismiss those jabs or twinges of pain as meaningless until eventually, they disappear. This groundbreaking research shows just how much more beneficial PRT can be than the usual care most people receive for chronic back pain. This is a hopeful message and one that Lin supports wholeheartedly in its quest to provide a holistic, multidisciplinary approach to chronic pain management. Join today and be paired with an empathetic and knowledgeable health coach who will work with you to design a PRT-based personalized care plan. Don’t wait! We want you to get back to living a full, pain-free life as soon as possible.