Unlearning Pain: How Psychological Therapy Could Aid Chronic Pain

One in five Americans have chronic pain, an intractable condition that costs the U.S. $600 billion annually and is fueling a deadly opioid epidemic. 

New research provides some of the strongest evidence yet that psychological treatment can provide relief.

“For a long time, we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that,” said lead author Yoni Ashar, who led the study while earning his PhD in the Department of Psychology and Neuroscience. “This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain.” 

Approximately 85% of people with chronic back pain have “primary pain,” meaning tests are unable to identify a clear bodily source. Misfiring neural pathways are at least partially to blame: In chronic pain patients, certain neural networks — like a false alarm stuck in the “on” position — become sensitized to overreact to even mild stimuli. 

Pain Reprocessing Therapy (PRT) seeks to silence the alarm. 

For the study, researchers recruited 151 chronic back pain patients. Those in the treatment group completed eight one-hour sessions of PRT in which they learned the brain’s role in generating chronic pain, practiced moving while reassessing their pain as safe rather than threatening, and explored emotions that may exacerbate pain.

After treatment, two-thirds of patients in the treatment group were pain-free or nearly pain-free and, for most, relief lasted one year or more. When they were exposed to pain in a brain scanner post-treatment, brain regions associated with pain processing had also quieted. 

“The magnitude and durability of pain reductions we saw are very rarely observed in chronic pain treatment trials,” said Ashar. The authors stress that the treatment is not intended for “secondary pain” rooted in acute injury or disease. 

Meanwhile, other similar brain-centered techniques are slowly being embraced by pain specialists, physical therapists and other clinicians. 

Said co-author and psychology and neuroscience professor Sona Dimidjian: “[This study] provides a potentially powerful option for people who want to live free or nearly free of pain.”

Submit feedback to the editor

Photo by iStock/Henrik5000