Fix PAIN with your BRAIN!? | PAIN REPROCESSING THERAPY (clinical study)

If you should be struggling with chronic pain, especially chronic pain for which doctors could find no physiological cause, then the following research results could be highly interesting for you. To be honest with you, the reason why I got into this topic of chronic pain and especially chronic back pain and chronic lower back pain is quite egoistic because I was struggling with chronic back pain for several years, which was probably caused by playing tennis excessively and without doing enough resistance training in order to counter the quite one-sided, the quite monotone use of muscles while playing tennis and by extended periods of sitting. Because when I was writing my books, of course, I was sitting all the time or when I was reading papers, of course, I was also sitting for extremely long periods and therefore the pain in my lower back became really bad and I really was convinced that there must be something broken. And of course, I did what I always do if I have serious problems. I took a look at the scientific literature and of course, what you find there is that you have to do sports, that you have to strengthen your core, which I did and I think it really helped a little bit. But the pain never did really go away. It became less but it did not go away and therefore, of course, I was also interested in psychological treatments because maybe my pain was not only produced by the area in which I felt the pain but maybe it was also caused by my brain. Because especially when it comes to back pain, there is a lot of research that could show that in about 85% of cases, there is no final physiological cause. There are so many people who are suffering from back pain even though doctors could not find any clue in their fMRIs. So maybe my pain was also caused by my brain. And after reading hundreds of studies about cognitive behavioral therapy for chronic pain and exposure therapy for chronic pain, I found an extremely interesting piece of research about pain reprocessing therapy. In this quite new study, 151 participants were randomly assigned to three groups. The first group was a weightless control group. They did not get any treatment at all. The second group was a placebo group. They received a saline injection into the side of their back which hurt. But interestingly, this was an open placebo so they were told that they are getting a saline injection. And of course, now you might say what the hell? Why do you tell people that they are getting a placebo? Well, from some studies, we know that placebos can even work if you know that you're getting a placebo. And the third group of course received the so-called pain reprocessing therapy which in the first place at the very core of pain reprocessing therapy is to make people believe and to convince them that the pain they are feeling, so for example my lower back pain, really is not the result of tissue damage or of bones that are scrubbing against each other but instead this kind of pain is produced by your brain. It is so-called centralized pain. So it is created by your central nervous system. And in order to convince people that this is really the case, they are first introduced to a physician who again makes sure that the pain they are feeling is not caused by any physical damage. He shows them all the evidence, all the medical evidence that there is actually nothing wrong in their body and therefore the only other conclusion you can come to is that the pain must be generated by your brain. And after this initial session with physician you also receive eight therapy sessions with a psychologist who also again helps you to find evidence that this pain you are feeling in your body actually is produced by your brain. Because if you succeed to believe that if you can be convinced that the pain was produced by your brain and not from tissue damage, then of course you can get another perspective on your pain. Then of course you can tell yourself well if there's no actual tissue damage then there is no reason to feel anxiety, there's no reason to feel alarmed all the time because actually there's nothing problematic going on in my body. And of course this kind of thought is much more calming, is much more reassuring and it helps your whole body and it helps your whole system to relax and to calm down. And you break the vicious cycle which is thought to have created your chronic pain. Because the vicious cycle probably is that as soon as you feel something in your body and you get alarmed that there might be something wrong and you might damage your body by moving into this or that direction, then you get even more anxiety, even more stress and this anxiety again causes more tension in your body and this tension again causes more pain. And the power of this vicious cycle can only be weakened by realizing well the pain is not a signal of my body that there's something broken, no it's probably just a false alarm of my brain. And to help patients to make this realization the therapist also asks a lot of questions like for example well do you feel that the pain moves in your body? So maybe sometimes it's in your lower back but then it's also in the middle and sometimes also in your upper back. And if this is the case well maybe then there is not this one single spot in your back that is really broken but instead is probably really caused by your brain. And another question that you might get in a pain reprocessing therapy is whether your pain is inconsistent. Well is it sometimes there for some hours and then it's maybe gone for three or four days or sometimes even a week. And this is of course also a hint that maybe this pain is not caused by something that is broken in your body because then you would expect that this pain is always there when you do a special movement for example but if it's sometimes there and then again sometimes it's not there well this might also be a hint that the pain is produced by your brain. And further evidence for that of course is if you are somebody who is struggling with depression or obsessive or compulsive disorder or especially with anxiety because we know from many studies that anxiety, stress, depression also can lead to centralized pain and it can keep pain from going away. But besides looking constantly for evidence that your pain is caused by your brain and therefore you don't have to feel your pain, pain reprocessing therapy also has some other elements like for example mindfulness. You learn that you can observe your pain in a neutral way and no longer in a completely negative way and you also get to learn a lot about self-compassion because many times we are much more patient with other people than we are patient with ourselves and by learning to be more nice to ourselves we also get more positive emotions which is also a very important part of pain reprocessing therapy which is also something a therapist might try to evoke by making you laugh and by using humor. So what were the results of this study? Well the results were really fascinating because whereas in the weightless control group only 10% after the treatment reported that their pain had completely gone or almost gone, in the placebo group 20% so the placebo treatment really seemed to have worked. 20% reported that their pain had almost gone or it was completely gone and in the pain reprocessing therapy 66% said that they had no longer any pain or almost no pain at all. So really impressive results and those kinds of results are very rare and of course therefore we also need a replication of those results there is no doubt for that but nevertheless the results are very promising and maybe in the future many people might benefit from this new pain reprocessing therapy. I hope you enjoyed this episode if you want to get to know more about evidence-based therapy methods of course feel free to take a look at the website or take a look at the books and maybe we will see you next time