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

This study was designed to test whether a psychological treatment aimed at changing patients' beliefs about the causes of pain and the value of threat (pain reprocessing therapy [PRT]) would result in substantial and lasting pain relief from primary CBP and to investigate treatment mechanisms.

Participants randomized to PRT participated in one telemedicine session with a physician and eight psychological treatment sessions over a four-week period.

As a result, 151 adults (54% female; mean [SD] age, 41.1 [15.6] years) reported mean (SD) pain of low to moderate severity.

Large group differences in pain were observed after treatment, with a mean (SD) pain score 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.

Of the total 151 participants, 33 (66%) of the 50 participants randomized to PRT reported no or almost no pain after treatment, 5 (10%) of the 50 participants randomized to placebo were randomized to usual care, and the treatment effect was maintained at 1 year follow-up The mean (SD) pain score was 1.51 (1.59) in the PRT group, 2.79 (1.78) in the placebo group, and 3.00 (1.77) in the usual care group.

From this analysis of the results, psychological treatments that focus on changing patients' beliefs about the causes of pain and the value of threats may provide substantial and lasting pain relief for people with CBP.