Effects of Pain Reprocessing Therapy versus Placebo and Usual Care in Patients with Chronic Low Back Pain
Ashar YK, Gordon A, Schubiner H, et al. Effect of pain reprocessing therapy versus placebo and usual care for patients with chronic low back pain: a randomized clinical trial. JAMA Psychiatry. Published online September 29, 2021. doi: 10.1001 / jamapsychiatry.2021.2669
Commentary
Treatment for chronic low back pain (CBP) is often ineffective, with approximately 85% of cases being primary CBP and no peripheral etiology identified.
These maintaining factors also include fear, avoidance, and the belief that pain indicates injury.
This study tested whether psychological treatments aimed at changing the cause of pain and the value of the threat would result in substantial and lasting pain relief from primary CBP and investigated treatment mechanisms.
Results examined average weekly back pain intensity scores (0-10), post-treatment, pain beliefs, and fMRI measures of evoked pain and resting connectivity, with 151 adults reporting mean (SD) pain of low to moderate severity.
Large group differences in pain were observed after treatment, with mean (SD) pain scores of 1.18 (1.24) in the PRT group, 2.84 (1.64) in the placebo group, and 3.13 (1.45) in the usual care group.
Hedge g was -1.14 for PRT versus placebo and -1.74 for PRT versus usual care (P <.001).
Of the 151 participants, 33 of 50 (66%) randomized to PRT had no or almost no pain after treatment, compared with 10 of 51 (20%) participants.
Five of 50 participants (10%) were randomized to placebo and five of 50 participants (10%) were randomized to usual care.
Longitudinal fMRI showed.
(1) PRT and placebo showed reduced response to evoked low back pain in the anterior cingulate cortex and prefrontal cortex.
(2) Decreased responses in the anterior insula of PRT and usual care.
(3) Increased resting state connectivity from the prefrontal and anterior cingulate cortices to the primary somatosensory cortex in PRT compared to both control groups.
(4) Increased connectivity of the PRT from the anterior midzone to the precuneus compared to usual care.
In conclusion of these results, psychological treatment may provide substantial and lasting pain relief to CBP patients.
