Pain reprocessing therapy (PRT): what is it and how does it work?

Pain reprocessing therapy is a promising tool for chronic pain.

Many people around the world suffer from chronic pain. This condition manifests itself in many different forms, such as headaches, back pain, neck pain, wrist pain... but all of them share the same unknown organic cause.

Although the physical cause of this discomfort is unknown, most treatments focus on treating the supposed organic cause behind it, or at least reducing the perception of Pain by means of drugs such as opiates.

But... What if the problem is in the brain, and is it possible to change the perception of pain? These are some of the questions that pain reprocessing therapy not only answers, but works with them to improve the quality of life of people with chronic pain. Let's find out more about this interesting psychotherapy.

What is pain reprocessing therapy?

Chronic pain is the reality of many people. It is not difficult to find someone who suffers from back pain, neck pain, headaches or feels that he or she is suffering from a repetitive strain injury, discomfort that is triggered every time he or she has to do certain activities that are easy and painless for most people, but that for this type of patient can become a great suffering.

There are many people who feel that their body aches without any apparent organic cause after performing a mundane task. For example, there are people whose back starts to ache when they have been walking for a while, their neck after sitting for several hours in the office or their wrist from typing on the keyboard.

These same people have gone to several specialists who have all answered the same thing: they cannot find the organic cause. However, the treatment is organic, using both occupational therapy and drugs.

But... But what if the key to chronic pain is not physical but psychological? After all, pain is nothing more than the brain's interpretation of the signals it receives from different parts of the body. It is the body's warning signal that alerts the brain that some tissue or organ is damaged.

However, in the case of chronic pain in the case of chronic pain, this signal is the brain's misinterpretation of a signal that it perceives as painful when it should not be.. This pain is called neuroplastic pain and is the result of the brain misinterpreting safe messages from the body.

Although the origin of this pain is psychological, this does not mean that neuroplastic pain is imaginary. In fact, neuroimaging techniques that have been used to address what is going on in the brains of patients with chronic pain show that the pain is quite real. Some recent research has shown that pain is often the result of learned neural pathways in the brain.. But, just as pain can be "learned", it can also be "unlearned".

That chronic back pain, neck pain, fibromyalgia symptoms, repetitive strain injury, headaches and other forms of chronic pain are not the result of structural causes but psychophysiological processes was already suspected. It has been as a result of new research and the approach of a new psychological therapy specifically geared for patients with chronic pain that it has been seen that this type of pain can be reversed. This is where pain reprocessing therapy comes in.

How is it used in patients?

Alan Gordon's group has developed a treatment called Pain Reprocessing Therapy (PRT). Based on the premise that chronic pain is the result of abnormal brain connections that perceive safe signals from the body as painful, the goal of this therapy is to "reweave" these connections with the intention of deactivating neuroplastic pain.. Just as the brain learns to associate a signal with pain, it can be unlearned with the use of appropriate techniques.

Pain reprocessing therapy includes several psychological techniques that retrain the patient's brain to respond to safe body signals in an appropriate manner, thus breaking the cycle of chronic pain.

Among these techniques is somatic tracking, which combines Mindfulness, Mindfulness, retrospective awareness, and mindfulness.which combines Mindfulness, reassessment of safety and induction of positive affect. The purpose of somatic tracking is to help patients see their painful sensation through a different, safer lens and thus attempt to deactivate the pain signal.

As we discussed earlier, patients with chronic pain often develop conditioned responses. That is, their brain establishes associations between certain physical activities and the occurrence of pain (e.g., walking causes back pain, writing causes wrist pain, sitting causes back pain...). Another component of DRT involves helping patients break these associations so that they themselves can do the activities without feeling pain.

The scientific evidence for its efficacy

A study conducted by the University of Colorado Boulder, in the United States, and published in the prestigious JAMA Psychiatry yielded scientific evidence of the efficacy of pain reprocessing therapy.

This study, carried out by the group of Yoni K. Ashar, Alan Gordon, Tor D. Wager and colleagues, found that about two-thirds of patients with chronic back pain who underwent a four-week psychological treatment based on this therapy felt little or no pain after receiving this treatment.. Most surprisingly, the majority maintained relief for a year.

The researchers themselves point out in their study that, for a long time, it has been thought that chronic pain is mainly due to unknown body problems, an idea on which most of the treatments to reduce this pain were based. Unlike classical treatments, which are oriented towards reducing the supposed source of the pain, DRT is based on the premise that the brain can generate pain in the absence of an injury or after it has healed, and that people can unlearn the source of pain.and that people can unlearn that pain.

Virtually most patients with chronic back pain (85%) have what is known as "primary pain," which means that medical tests cannot identify a clear bodily source, such as tissue damage.

As we have already mentioned, abnormal neuronal pathways are responsible for the perception of this pain. Several brain regions, including those related to reward and fear, are activated more during chronic pain episodes than during acute pain episodes.

In their study, Wager and colleagues recruited 151 men and women who had back pain for at least six months with an intensity of at least four on a scale of zero to 10. These participants were divided into three groups: DRT therapy, placebo and no therapy, and the subjects' brains were assessed before and after treatment, specifically using functional magnetic resonance imaging (fMRI) scans to measure how their brains reacted to a mild pain stimulus.

After treatment, 66% of patients in the treatment group felt no or almost no pain, compared to 20% in the placebo group and 10% in the no-treatment group. When people in the PRT group were exposed to pain and assessed by neuroimaging after treatment, the brain regions associated with pain processing, including the anterior insula and anterior median nerve, had significantly quieted, brain regions associated with pain processing, including the anterior insula and the anterior median nerve, had significantly quieted..

This study is considered one of the strongest pieces of evidence that psychological therapy can improve the quality of life of patients with chronic pain, yielding results that have not been seen with other treatments, with a durability and magnitude of pain reductions rarely seen in trials of other chronic pain management techniques.

It should be said, however, that the authors of both this study and those who have proposed pain reprocessing therapy do not consider it to be effective for what is known as secondary pain, that which does have its origin in an acute injury or disease. Wager's study focused specifically on pain reprocessing therapy for chronic back pain, so further larger studies will be needed to determine whether it yields results as good as those seen in these patients.

Be that as it may, both this study and the still scarce but promising clinical practice with DRT attest to the fact that it is a good therapeutic tool to improve back pain. a good therapeutic tool for improving the quality of life of people suffering from chronic pain and even eliminating it.. Seeing this pain in a new light, understanding that it is a false alarm signal and that everything in the body is going well, understanding that it should not be perceived as a danger signal and unlearning pain is a good tool to improve the quality of life of patients.

Pain reprocessing therapy shows great promise as a potentially powerful option. for people suffering from chronic pain who wish to live free of this discomfort.