Can our brain learn to forget about chronic pain? Pain Reprocessing Therapy - a new psychological approach, demonstrates promising results.

Riding a bicycle consists of a combination of complex movements. One has to pedal, balance and steer at the same time. When a child tries to ride a bike for the first time, they will fall. They will try again and fall again. With every trial, their brain establishes and strengthens connections between regions that are responsible for the different movements that together make up biking. Over time, the connections between the relevant regions in the brain become so strong that biking becomes natural. They can do it without thinking and they’ll never forget it.

Over time, connections between relevant brain regions become strong enough for biking to become natural. Children riding bicycles | Shutterstock

How does chronic pain develop?

The same principles that enable our brain to learn biking, enable it to learn being in pain. Chronic pain - pain that usually lasts longer than 6 months - affects about 20% of adults worldwide. While some of these people experience pain due to injuries or chronic diseases that actually take longer to heal or that cannot be cured, the majority suffer from a type of pain that is learnt, so called neuroplastic pain.

Chronic pain affects about 20% of adults across the globe. Image: Shutterstock

Pain is a danger signal. When you have appendicitis (an inflammation of the appendix), your brain uses pain to tell you that something is wrong and that it is time to go to the emergency room. After the surgery, the affected tissues take a few weeks to heal. During this time, moving hurts, eating hurts, anything that touches your belly hurts. This pain helps you avoid movements that may lead to additional damage to the affected areas. In some cases, the brain learns to associate the actions of eating, moving or touching with danger (in the current example), and keeps sending a danger signal (pain) long after the body has recovered.

Pain reprocessing therapy

Similar to biking, your brain can’t just forget pain. But it is possible to unlearn pain, when it seems there should be no physical cause for it, by establishing new neural connections that overwrite the old ones. A new method called Pain Reprocessing Therapy (PRT) aims to look at these false danger signals and teach your brain that there’s no actual danger. The method relies on a combination of mind-body psychological approaches, such as Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction, in combination with pain neuroscience education.

The method was developed by American psychotherapist Alan Gordon, and was first demonstrated to be successful in treating chronic pain in the Boulder Back Pain Study. In this study, 151 participants, all suffering from chronic back pain, were randomly distributed into three groups. The PRT group received biweekly psychological therapy sessions for one month, aimed at unlearning their pain. The control group continued with their regular treatment, such as attending physiotherapy sessions or taking pain relievers. The placebo group received a so-called ‘open-label placebo’. Patients assigned to this group knew that they were receiving a placebo in the form of a saline injection. Interestingly, it has been previously demonstrated  that open-label placebo works in a similar fashion to closed-label placebo therapy, effectively reducing physical symptoms

The study found that 73% of the participants in the PRT group who have  successfully completed the treatment, were fully or nearly pain-free after the treatment and continued to be so at the 1-year follow-up. Meanwhile, only 10% of the regular treatment group and 20% of the placebo group showed similar levels of improvement. Functional Magnetic Resonance Imaging (fMRI) of the patients’ brains showed high activity of pain centers in the brain at the beginning of the study, which diminished following the psychological treatment.

Since then, a group from Harvard University demonstrated promising results using a similar mind-body connection-based psychological approach to treat chronic back pain, re-emphasizing the usefulness of such an approach.

Functional Magnetic Resonance Imaging (fMRI) of the left hemisphere of the human brain. fMRI scans of patients’ brains showed diminished activity in pain centers following PRT. 

The Boulder Back Pain Study was limited to well-educated trial participants with low or moderate back pain levels. Hence it cannot be generalized to the average population, or to sufferers of other types of chronic pain. Despite its limitations, it establishes PRT - a psychological approach aimed at unlearning pain caused by false danger signals - as a promising method for the  treatment of chronic back pain. In his popular science book Gordon also describes case studies of successful treatment of patients with chronic knee pain, irritable bowel syndrome, fibromyalgia and other forms of chronic pain, using pain reprocessing therapy, showing the potential of the approach for the treatment of a diverse range of chronic pain ailments, beyond back pain.