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A new study suggests that a style of talk therapy could help people find relief from chronic pain. Nadija Pavlovic/Getty Images
  • People who learned to see their chronic pain as “in the brain or mind” had a reduction in the pain intensity, a new study shows.
  • All pain is real, but some does not have an underlying physical cause such as an injury or tumor.
  • Negative thoughts and emotions can worsen chronic pain, but the reverse is also true — positive thoughts and emotions can relieve pain.

Helping patients understand that chronic pain is often “in the brain or mind” can help reduce the intensity of their pain, a new study shows.

This does not mean that people are imagining their pain, because all pain is real — and all pain is generated by neural circuits in the brain.

But in cases where their pain does not have a physical cause — such as a tumor, bone fracture, infection or inflammatory condition — shifting their perspectives about the role of the brain in chronic pain can give people more control.

“We found that very few people believed their brains had anything to do with their pain,” study author Yoni Ashar, PhD, assistant professor of internal medicine at the University of Colorado Anschutz Medical Campus, said in a news release.

“This can be unhelpful and hurtful when it comes to planning for recovery, since pain attributions guide major treatment decisions, such as whether to get surgery or psychological treatment,” he said.

The study, published Sept. 28 in JAMA Network Open, examined the link between the brain and chronic pain. Specifically, researchers looked at the importance of people’s beliefs about the underlying causes of their pain, also known as “pain attributions.”

The study looked at data from a clinical trial involving a treatment called pain reprocessing therapy (PRT), which teaches people to see pain signals sent to the brain as less threatening. PRT is a type of talk therapy that draws from cognitive behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR).

Researchers enrolled over 150 adults with moderately severe chronic back pain. They randomly assigned participants to receive PRT, an inactive placebo injection, or usual care.

In an earlier paper from the same trial, published in JAMA Psychiatry, researchers found that two-thirds of people with chronic back pain who did PRT were pain-free or nearly pain-free after 4 weeks, compared to fewer than one-fifth of people who received the placebo or usual care.

The new paper focuses on understanding how people recovered from chronic back pain after undergoing PRT.

At the start of the trial, only 10% of participants’ beliefs about the underlying causes of their pain were related to the mind or brain, across all three groups.

In people who did PRT, this increased to 51% by the end of the treatment period. In contrast, only 8% of participants’ beliefs in the placebo and usual care groups were brain- or mind-related by the end of the 4 weeks.

In addition, the more that participants shifted to seeing their mind or brain as the source of their pain, the greater the reduction in their reported back pain intensity, researchers found.

“The take-home message [from this study] for people with chronic pain is that because pain is processed in the brain and these networks are not hardwired, there are things they can do to help reset some of these networks and reduce the experience of pain,” said Afton L. Hassett, PsyD, associate professor and director of clinical pain research in the Department of Anesthesiology at the University of Michigan.

Hasset, author of “Chronic Pain Reset: 30 Days of Activities, Practices, and Skills to Help You Thrive,” was not involved with the new study, but her team has worked with some of the researchers on past projects.

“The work they are doing is compelling,” she told Healthline. “For the subset of patients who do have the type of pain that responds to PRT, the results can be dramatic. This current study helps us better understand how the treatment might be working.”

One reason PRT may help certain people with chronic pain, said Ashar in the release, is it teaches them that the pain is a “false alarm” that they don’t need to be afraid of.

The alarm itself is real, but there is no underlying injury, inflammation or other physical cause — or no “fire” causing the alarm.

People with chronic pain can sometimes get stuck in an endless loop: pain triggers feelings of fear, which switches the brain into high alert. This can make the pain worse, which in turn, deepens their fear, and so on.

“Pain is processed in the brain using many of the same structures and networks as those used for processing thoughts and emotions,” said Hassett. “That’s why when we feel frightened or sad, our pain can feel much worse.”

But the reverse can also be true, with positive thoughts and emotions reducing feelings of chronic pain.

“If you have pain and find yourself laughing with a friend or deeply engaged in doing something you love, you might not notice or even feel your pain,” said Hassett.

New research shows that people with chronic back pain who underwent pain reprocessing therapy (PRT) were more likely after treatment to see their pain as stemming from their mind or brain.

This shift in beliefs about the source of their pain was associated with a decrease in the intensity of their pain.

PRT is appropriate for only certain types of chronic pain, specifically pain without an underlying physical cause such as injury, tumor or inflammation.