A New Way to Treat Back Pain -PRT

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‘Pain reprocessing therapy’ hopes to offer an alternative to drugs or surgery

By Sumathi Reddy -wsj  




What if the best way to treat your chronic back pain is by retraining your brain?

That’s the premise of a novel approach to chronic pain. Many people feel pain even after a physical injury has healed or when doctors can’t find a physical cause. The approach, called “pain reprocessing therapy,” tries to train the brain not to send false pain signals. Some early results are promising.

In a study published last year in JAMA Psychiatry, 66% of a group of people who did the therapy for a month were pain-free or nearly pain-free up to a year later.

The treatment is still largely in the research stages and typically not covered by insurance, but is being performed in a growing number of centers, including the VA Eastern Colorado Health Care System, which plans to start two clinical trials of the technique next year.

“Most physicians are taught in medical school that pain is biomechanical in nature,” says Alan Gordon, founder of the Pain Psychology Center in Los Angeles, who conducted many of the PRT treatments for the patients in the JAMA study. “This idea that the brain could… actually misinterpret the signals from the body as dangerous when they’re not is relatively new.”

A search for new approaches

Doctors and researchers have long been on a quest for effective treatments for chronic pain. Chronic back pain in particular is notoriously difficult to treat and experienced by millions of Americans. With doctors more wary of prescribing opioids, patients often now cycle through physical therapy, steroid injections and acupuncture, with surgery sometimes used as a last resort.

Some patients use techniques borrowed from mental-health therapy to try to manage pain symptoms, but researchers hope pain reprocessing therapy can go a step further by actually eliminating pain caused by off-kilter brain signals.



Some skepticism surrounds new approaches to pain treatment, but many doctors are hopeful they will succeed because the existing options can be ineffective, leaving patients still struggling with pain. PHOTO: GETTY IMAGES

After an injury, brain circuits can become hypersensitive to prevent you from getting hurt again, says Tor Wager, a psychology and neuroscience professor at Dartmouth College and senior author of the 2022 JAMA Psychiatry study.

That’s helpful while you’re recovering but once the injury is healed, chronic pain can persist because the brain is sending out false alarms, presuming danger when there is none, he says.

“You can get stuck in this hypersensitive phase,” he says.

Doctors and psychologists stress that this kind of pain, called neuroplastic pain, is real and not imagined. The cause is brain sensitization rather than a physical injury, says Wager.

Before beginning pain reprocessing therapy, doctors scan patients to make sure the pain isn’t being caused by a physical injury or something else such as a tumor or infection, which are medical conditions that aren’t appropriate for pain reprocessing therapy.

Therapists then talk with patients about their pain and the brain’s role in it. They encourage people to pay close attention to how the body feels. Patients use exposure techniques, doing gradual movements they think will cause pain to teach the brain that those movements aren’t actually harmful.

For example, if your back hurts when you bend forward, a psychologist would guide you through gentle bending while verbally reappraising the sensation as a false alarm and noting it so that it’s not considered threatening or painful, says Wager.

Hope and questions

Yoni K. Ashar, a clinical psychologist, neuroscientist and assistant professor of internal medicine at University of Colorado Anschutz Medical Campus in Aurora, has been using pain reprocessing therapy for chronic pain patients for about five years. The work includes patients with migraines, ankle pain and back pain, among other conditions.

Patients’ pain is often resolved within eight to 10 sessions, says Ashar, who was first author on the JAMA Psychiatry study. “One of the really intriguing ideas that comes out of this is reconceptualizing chronic pain as more of a psychiatric or mental health condition,” he says.

Some doctors are skeptical about overstating the promise of PRT and similar treatments.

Dr. Daniel Clauw, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, says he worries about the “over psychologizing of chronic pain.”

He says he thinks the approach can be helpful for some but not all patients. Many chronic- pain patients have other conditions, such as depression or anxiety, but that doesn’t mean that’s what’s driving their pain, he notes.

Still, many doctors are hopeful that alternate treatments will pan out because the existing options don’t always work, leaving patients still struggling with pain.

Back surgeries aren’t typically very effective unless done for sciatica or something specific, like a tumor or fracture, says Dr. Eeric Truumees, an orthopedic surgeon and professor at Dell Medical School at the University of Texas at Austin. Most patients with chronic back or neck pain don’t have a clear cause, he says.

“Finding other ways of addressing that pain is really a critical thing,” he says.




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