Pain Reprocessing Therapy
A randomized controlled study at the University of Colorado Boulder validated Pain Reprocessing Therapy (PRT) as the most effective current treatment for chronic pain. In the study, there were 100 chronic back pain patients. Half of them received PRT twice a week for four weeks, and half of them received treatment as usual. In the PRT group, 98% of patients improved and 66% of patients were pain-free or nearly pain-free at the end of treatment. These outcomes were largely maintained one year later.
Additional studies on the efficacy of Pain Reprocessing Therapy are currently underway.
The Body Is Not the Culprit
It’s simply intuitive to conclude that if you have chronic pain, there must be something wrong with your body. But many recent studies have shown that structural abnormalities in the body are often incidental, and not the cause of pain.
Authors of a New England Journal of Medicine study found that 64% of people with no back pain have disc bulges, protrusions, herniations, or disc degeneration. These structural abnormalities are actually quite normal and often unrelated to pain. Furthermore, researchers at the University of Washington found psychological factors to be more predictive of the onset of back pain than any of the physical variables analyzed.
Chronic whiplash syndrome is another big area of research. Whiplash describes head or neck pain resulting most often from a rear-end traffic collision.
Research has shown about 10% of whiplash injuries result in chronic pain or disability. However, the medical community has found no structural basis for chronic whiplash syndrome. The body heals, yet the pain persists.
In the country of Lithuania, the general public has little to no awareness about the potentially disabling effects of whiplash. A randomized controlled study found zero Lithuanian collision victims suffered from persistent head or neck pain as a result of their accident.
To test the cause of chronic whiplash further, researchers conducted a study placing a group of volunteers in a placebo collision. The experiment simulated a car crash with corresponding sights and sounds, though no physical impact occurred to the body. Three days later, 20% of subjects reported symptoms of whiplash. Four weeks following, 10% were still symptomatic. Such results led researchers to determine that the cause of chronic whiplash syndrome is unrelated to physical injury.
The Source Lies in the Brain
While it’s natural to intuit that chronic pain is caused by a problem in the body, recent studies have found that the true source of chronic pain often lies in the brain.
Researchers at Northwestern University tracked a group of patients after an initial episode of back pain and set out to predict who would go on to develop chronic pain. Rather than conducting physical back exams or taking X-rays or MRIs of the spine, scientists used fMRI brain scans to determine the level of connectivity between two key areas. Simply by looking at the brain, researchers were able to determine with 85% accuracy whose pain would persist and whose would resolve.
So how exactly is the brain able to learn pain?
A seminal study conducted some years ago demonstrated this process in action. The researchers scanned the brains of people who had recently injured their back and found that the pain was associated with activity in standard pain-processing regions, like the somatosensory cortex and thalamus - as expected. But when they scanned those same people one year later, the pain had shifted to brain regions associated with memory, learning, and emotion among those who had developed chronic pain.
These brain changes can cause the pain to persist "on loop" in the brain, relatively independent of any injuries that may or may not be present in the body.