Pain Reprocessing Therapy (PRT): A New Way to Understand and Treat Chronic Back Pain? Video Lay Summary

Pain Reprocessing Therapy (PRT): A New Way to Understand and Treat Chronic Back Pain? Written Lay Summary

Imagine you have chronic back pain that no amount of physical therapy or medication seems to resolve. Such persistent pain not only affects your ability to do everyday activities but also impacts your mental health and overall quality of life. Pain Reprocessing Therapy (PRT), a form of psychological treatment designed to help individuals change their beliefs and experiences of pain, offers an alternative way to address pain compared to more traditional medical management (e.g., taking tablets, other medications or surgery).

The nature of chronic back pain

Chronic back pain (CBP) can be debilitating and frustrating, especially when its causes are not clearly linked to physical damage or illness in the body. Traditional medical treatments often focus on symptom relief without addressing psychological factors that may amplify pain. PRT emerges as a new treatment that challenges traditional medical treatment s by focusing on how the brain interprets and processes pain signals.

What does Pain Reprocessing Therapy (PRT) look like?

In this study, people in the PRT group first had a one-hour online consultation with a physician (medical doctor). This session involved reviewing their pain history and explaining how their pain could be coming from the brain rather than damage in the back. After this, they attended eight one-hour sessions with a trained therapist over four weeks. These sessions included:

• Cognitive techniques – learning ways to re-think and reframe pain signals as safe rather than dangerous.
• Somatic techniques – paying attention to body sensations in a calm way.
• Exposure techniques – gently facing movements or activities they had been avoiding because of pain.

The overall aim was to help people see their pain as a ‘false alarm’ from the nervous system and reduce fear around it.

What the study did, in a nutshell

In an effort to see if PRT is effective, researchers from the USA organised a randomised controlled trial (RCT), involving three groups (for more information about RCTs see the ‘Quality Guide’ page here: https://thecollaborativelibrary.com/glossary-of-terms-and-jargon-buster/). One group received PRT, another given a placebo (a dummy treatment that people were aware was a dummy treatment, known as ‘open label’ – in this case a saline injection just under the skin in the back), and a third continuing with usual care.

To ensure the trial was done properly, participants were assigned to each group using randomisation, which helped to balance people’s characteristics, such as age, sex, pain ratings at the start of the trial, and opioid medication use across the tested groups. This should have gone some way to give a more accurate idea of how effective PRT might be for people with chronic pain beyond this group. For instance, it might be that older people, or those with worse pain at the start of the trial, might respond differently to the therapy compared to say younger individuals, or perhaps those rating lower pain levels. Similarly, opioid use could affect people’s experience of pain and treatment outcomes, making its consideration vital when thinking about how people got on with the treatment. The study measured outcomes related to pain intensity (i.e. severity of pain), emotional well-being, and their ability to function, in terms of how much pain interfered with people’s lives but also depression, anxiety, anger, and sleep quality, across a year. Measuring these outcomes over a longer period of time was important to gauge the long-term effectiveness of the treatment, ensuring that any benefits provide real, lasting relief or management for people with CBP. The longer follow-up also helped to see if any delayed effects of the treatment might be happening.

What did they find?

People in the PRT group reported a significant reduction in pain intensity compared to those in the placebo and usual care groups. And these improvements were sustained throughout the year, suggesting that PRT could offer long-lasting benefits. This finding is critical as it highlights the potential of psychological therapies to modify the brain’s response to pain, possibly leading to sustained pain relief or management without the need for ongoing treatment or intervention. However, not everyone completed the study, and more people withdrew from the placebo and usual care groups compared to PRT. This means the results should be interpreted with some caution.

Safety and practical considerations

An important aspect of the study was the safety profile of PRT. Unlike many invasive treatments like medication or surgery that carry risks of side effects, PRT was associated with no adverse effects, suggesting it may be a safer alternative for long-term pain management. Although the study did not directly analyse the costs associated with PRT, the potential reductions in the use of pain medication and other treatments could come with reduced costs to the economy.

What this means?

This study is not just about treating back pain but also about understanding it from a new point of view. By shifting the focus to how pain is processed in the brain, PRT provides a new way of approaching chronic or nerve-related (so called ‘neuropathic’) conditions, potentially shaping new pain management strategies in healthcare. However, because PRT in this study draws on elements also found in established therapies such as Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Compassion-Focused Therapy (CFT), it remains uncertain whether PRT offers additional benefits at this stage. Further research is needed to see if this is the case.

Next steps

Further research is needed to repeat these findings across a diverse range of people and to work out the balance between the cost of the treatment versus how it is effective it is (i.e. cost-effectiveness) of offering PRT in routine clinical settings. It might also be the case that combining or integrating PRT with other treatments may also strengthen its effectiveness for a variety of people.

To sum up…

The study on Pain Reprocessing Therapy (PRT) is a potentially helpful advancement in the treatment of chronic back pain. By addressing how we think about pain, PRT offers a promising path forward for those who have found little relief with traditional medical treatments. It encourages a re-thinking of pain management strategies, emphasising the need for treatments that target the psychological as well as the physical aspects of pain, where one cannot exist without the other. However, this is just one study, and therefore further trials are needed to see if it is effective across a range of people and diverse populations before it can be said it should be an effective treatment of choice.