Pain Reprocessing Therapy (PRT): What It Is And How It Works
Many people around the world suffer from chronic pain. This alteration manifests itself in very different forms, such as headaches, back pain, neck pain, wrist pain… but they all share that it is not known what their organic cause is.
Although the physical cause of these discomforts is unknown, most treatments focus on treating the supposed organic cause behind it, or at least reducing the perception of pain through drugs such as opiates.
But… What if the problem is in the brain? 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. to improve the quality of life of people with chronic pain. Let’s discover more about this interesting psychotherapy.
Chronic pain is the reality for many people. It is not difficult to find someone who complains that their back hurts, their neck hurts, they have headaches or they feel like they are suffering from a repetitive strain injury, discomfort that triggers every time they have to do certain activities that are easy and painless for the majority. , but for this type of patient it can become great suffering.
There are many people who feel that their body hurts without apparent organic cause after performing a mundane task. For example, there are people whose back starts to hurt 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. Of course, the treatment is organic, using both occupational therapy and drugs.
But… What if the key to chronic pain was 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 tells the brain that some tissue or organ is damaged.
However, In the case of chronic pain, this signal is the brain’s misinterpretation of a signal that it perceives as painful when it shouldn’t.. This pain is called neuroplastic pain and is the result of the brain making a mistake in interpreting 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 happens in the brains of patients with chronic pain show that pain is quite real. Some recent research has shown that Pain is often the result of learned neural pathways in the brain. But, in the same way that 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 rather psychophysiological processes was already suspected. It has been as a result of new research and the proposal of a new psychological therapy specifically aimed at 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). Starting from 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.. In the same way that the brain learns to associate a signal with pain, it can be unlearned with the use of the right techniques.
Pain reprocessing therapy includes several psychological techniques that retrain the patient’s brain to respond to safe body signals appropriately, thus breaking the cycle of chronic pain.
Among these techniques we find somatic tracking (“somatic tracking”)., which combines Mindfulness, safety reappraisal, and positive affect induction. The purpose of somatic monitoring is to help patients see their painful sensation through a different, safer vision, and thus try to deactivate the pain signal.
As we have mentioned before, patients with chronic pain often develop conditioned responses. That is, your brain establishes associations between certain physical activities and the onset of pain (e.g., walking causes back pain, writing causes wrist pain, sitting causes back pain…). Another component of TRD involves helping patients break these associations so they can do the activities themselves without feeling pain.
A study led by the University of Colorado Boulder, in the United States, and published in the prestigious JAMA Psychiatry provided scientific evidence of the effectiveness 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 in this therapy they felt almost no pain or no pain after receiving this treatment. And the most surprising thing is that the majority maintained the relief for a year.
The researchers themselves highlight 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 treatments to reduce this pain were based. Unlike classic treatments, aimed at reducing the supposed source of pain, TRD is based on the premise that the brain can generate pain in the absence of injury or after it has healedand 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 neural pathways would be responsible for the perception of this pain. Various regions of the brain, including those related to reward and fear, are activated more during episodes of chronic pain than during those of acute pain.
In their study, Wager and colleagues They 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 ten. These participants were divided into three groups: TRD therapy, placebo and no therapy, and the subjects’ brains were evaluated before and after treatment, specifically using functional magnetic resonance imaging (fMRI) scans to measure how their brain reacted to a stimulus. soft pain.
After treatment, 66% of patients in the treatment group felt no or almost no pain, compared with 20% in the placebo group and 10% in the no-treatment group. When people in the PRT group were exposed to pain and assessed using neuroimaging after treatment, Brain regions associated with pain processing, including the anterior insula and anterior median nerve, had quieted significantly.
This study is considered one of the strongest evidence that psychological therapy can improve the quality of life of patients with chronic pain, giving results that have not been observed in other treatments, with a durability and magnitude of pain reductions. which are very rarely observed in trials with other chronic pain treatment techniques.
It should be said, however, that the authors of both this study and those who have proposed pain reprocessing therapy do not consider that it is effective for what is known as secondary pain, which does have its origin in an injury or acute illness. . Wager’s study focused specifically on pain reprocessing therapy for chronic back pain, so more larger studies will be needed to determine if results are 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 TRD attest that it is a good therapeutic tool to improve the quality of life of people who suffer from chronic pain and even eliminate it. Seeing this pain from a new perspective, understanding that it is a false alarm signal and that everything in the body is fine, understanding that it should not be perceived as a danger sign and unlearning pain is a good tool to improve quality of life. from the patients.
Pain reprocessing therapy shows great promise as a potentially powerful option for people suffering from chronic pain who want to live free of this discomfort.
