Rhys Blakley

The Times

Gerry Gajadharsingh writes:

“I have written before on the concept of “central sensitisation” in relation to many chronic pain syndromes, not just chronic back pain.

 It relates to the concept that in some patients, long-term pain does not stem from a bodily injury. Instead, it is thought to be caused by the brain becoming overly sensitive to stimuli that would not normally cause discomfort.

In my practice it’s more than a concept and we use various techniques to help the patient desensitise their brain and nervous system to help manage chronic pain syndromes, especially breathing re-education and visualisation techniques.

I think that the closing paragraph of the article on the research is extremely important

Tor Wager, of Dartmouth College, the senior author of the study, which was published in JAMA Psychiatry, said: “This isn’t suggesting that your pain is not real or that it’s all in your head. “What it means is that if the causes are in the brain, the solutions may be there too.”

The challenge is to persuade patients to move away from the concept of continuing damage of whatever part of the body they think is damaged, to the fact that the brain and nervous system is simply sensitised and overstimulated.

Our thoughts affect our physiology and our responses to pain. Helping patients, through a variety of tools, to desensitise this process is often extremely helpful.”

A four-week course of psychological therapy can dramatically reduce chronic back pain for many patients for at least a year, a study suggests.

The research is the first to assess pain reprocessing therapy (PRT), a treatment that assumes that in some patient’s long-term pain does not stem from a bodily injury. Instead, it is thought to be caused by the brain becoming overly sensitive to stimuli that would not normally cause discomfort.

During talk therapy sessions, patients are given advice on how to “retrain their brains” to reduce pain levels.

The study involved 150 volunteers who had lived with back pain for an average of ten years each and were split into three groups. Among those who took part in eight PRT sessions in a month, 66 per cent were pain-free, or nearly pain-free, a year later.

For those given a placebo treatment only 20 per cent reported a similar improvement; among those given no treatment it was 10 per cent.

“For a long time, we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that,” Yoni Ashar, of Cornell University in New York, said.

“This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain. Our study shows it works.”

About one in five UK adults will experience chronic pain. A majority of people with chronic back problems have “primary pain” — meaning that doctors are unable to identify a clear bodily source, such as tissue damage.

The researchers suspect that after an initial short-term injury, the brain unconsciously falls into a kind of trap where certain situations, such as changes in the weather or bending forwards, become associated with pain.

Even when the stimuli are unable to cause physical damage, the brain responds defensively by creating pain, with certain neural networks becoming primed to react automatically.

“By thinking about the pain as safe rather than threatening, patients can alter the brain networks reinforcing the pain, and neutralise it,” Ashar said.

Before and after the treatment, participants were scanned to measure how their brains reacted to a mild pain stimulus. Among those given PRT, brain regions associated with the processing of pain signals showed reduced activity.

Tor Wager, of Dartmouth College, the senior author of the study, which was published in JAMA Psychiatry, said: “This isn’t suggesting that your pain is not real or that it’s all in your head.

“What it means is that if the causes are in the brain, the solutions may be there too.”

Behind the story

A typical pain reprocessing therapy (PRT) session involves an exercise in “somatic tracking”. The therapist begins by asking the patient to close their eyes and take slow breaths (Rhys Blakely writes).

The theory is that the brain is receiving “safe, normal signals” from the body, but that it is misinterpreting them as dangerous — and therefore producing a sensation of pain. The aim is to teach the brain how to interpret the signals properly.

In a recorded version of the exercise available online, Alan Gordon, the psychotherapist who developed PRT, asks his patient to bring their attention to the dominant physical sensation in their body. He adds: “You’re not trying to change it; you’re just familiarising yourself with it.”

This exercise lasts about seven minutes. Gordon says: “You’re developing the neural pathways to pay attention to this physical sensation without fear, without any judgment, without any ulterior motive or any goals.”