Research

One of the most groundbreaking studies in chronic pain research, conducted at the University of Colorado Boulder, tested a psychological approach called Pain Reprocessing Therapy (PRT) against placebo and standard care.

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151 adults with chronic back pain were recruited between 2017 and 2020, with an average pain duration of 10 years and randomly assigned to one of three groups: Pain Reprocessing Therapy (PRT), open-label placebo injection, or usual care. The PRT group received 8 individual one-hour sessions over 4 weeks, focused on reappraisal of pain, psychosocial coping techniques, and increasing positive emotional states. All participants underwent clinical assessments and functional MRI scans at baseline and at follow-up.

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The core premise:

the brain had learned to keep firing pain signals long after any physical cause was present. By learning to reinterpret those signals as safe rather than threatening, the brain could rewire itself.

Immediate Outcomes

At the end of treatment, 98% of PRT participants showed measurable improvement, and 66% were pain-free or nearly pain-free, compared to 20% in the placebo group and just 10% in the usual care group. Post-treatment fMRI scans confirmed that brain regions associated with pain processing, including the anterior insula and anterior midcingulate, had quieted significantly. These are objective, measurable neurological changes not a shift in mood or perception alone.

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Ongoing Recovery: The 5-Year Follow-Up

113 of the original 151 participants provided data at the 5-year mark. PRT participants continued to report significantly lower pain intensity than both comparison groups with an adjusted mean pain score of 1.93, versus 3.19 in the placebo group and 2.60 in the usual care group. 55% of PRT participants remained nearly or completely pain-free at 5 years, compared to 26% in the placebo group and 36% in usual care. The PRT group also showed sustained improvements in pain interference, depression, anger, and fear of movement.

More than half of those who became pain-free after treatment stayed pain-free five years later without any ongoing treatment. The lead researcher noted that the goal of PRT is not pain management but recovery. The understanding is that chronic pain is something the brain can unlearn.

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 Read the original study: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2784799
Read the 5-year follow-up: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2833985

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