When the brain can control pain: A study on patients with chronic low back pain shows that more than two-thirds of patients who undergo “pain reprocessing therapy” (PRT) do not experience much pain or After about four weeks of treatment, a very significant result versus placebo or the usual treatment. This improvement is accompanied by functional MRI changes of the areas of the brain involved in the treatment of pain.

This study published in the journal JAMA Psychiatry, will also show that most patients have relief even after a year of treatment. This psychotherapy is not definitively indicated when a cause for low back pain is identified, which is more common after a good clinical examination than the authors suggest.

a randomized trial

The patients enrolled in this randomized open-label trial are 151 men and women who had experienced low back pain for at least six months without any apparent cause, at least four on a scale of zero to ten. with pain of intensity.

Patients in the pain reprocessing therapy psychotherapy group were initially assessed and followed by an eight-hour PRT session over 4 weeks.

The aim of this psychotherapy is to educate the patient about the role of the brain in the development of chronic pain, to promote a re-concept by patients with primary chronic pain (“nociplastic”) as false alarms generated by the brain. Help him re-evaluate his pain when he performs actions that he fears, and help him deal with feelings that may be increasing his pain.

Before and after treatment, the participants also had functional magnetic resonance imaging (fMRI) scans to measure the response of different regions of their brain to a mild painful stimulus.

very important result

Of the total 151 participants, 66% of participants (33 out of 50) randomized to the PRT group experienced no or almost no pain at 4 weeks, compared with 20% of participants (10 out of 51) in the placebo group. and 10% of participants (5 out of 10) randomized to the usual treatment group.

Longitudinal MRI shows less evoked pain responses to PRT in the anterior middle cingulate region and anterior prefrontal cortex compared to placebo; Fewer responses in the anterior insula to PRT compared with usual care; and increased resting connectivity of the anterior prefrontal cortex and anterior insula of the primary somatosensory cortex for PRT compared to the two control groups.

modify neural circuits

Typically, 80% of people with chronic low back pain have “primary pain” or “nocyplastic,” meaning the tests do not identify a clear organic source of their pain. With a good clinical examination and proper exploration, this percentage has decreased in recent years, but a significant percentage of patients still have primary chronic low back pain that severely disables them.

An abnormality of the neural circuit is, at least in part, responsible for this primary chronic low back pain or nociplasticity. Studies have shown that different areas of the brain, especially those associated with reward and fear circuits, become more active in these patients during episodes of chronic pain than during episodes of acute pain. In patients with chronic pain, certain neural circuits are sensitive and over-react to stimuli, even mild or painless.

So, while pain has traditionally been a red flag that something is wrong with the body, according to the authors primary chronic pain is “like an alarm sounded in an inappropriately ‘on’ position.” this study.

solid evidence

These results are one of the strongest evidence to date that psychotherapeutic treatment can provide clinically meaningful and lasting relief from chronic low back pain.

This does not mean that the pain is not real or that it is “in the patient’s head”. In other studies it has been shown that changes in neural circuits in the brain can persist even after pain subsides. This means that if the causes are in the brain, solutions can also be found there: “the alarm can be reset to the off state”.

Rethinking the causes of chronic pain and the extent of its danger may provide lasting relief to patients and modify the neural processes associated with the treatment of pain.

A study must be confirmed before making generalizations

This study focused on PRT in chronic low back pain, so larger studies are needed to determine whether this psychotherapy can produce similar results in other types of chronic pain.

But this study offers a new, potentially powerful option for people with the condition. Other similar psychotherapeutic techniques have been developed, focusing on abnormal brain function and should also be evaluated.