Pain reprocessing therapy (TRD): what it is and how it works

Many people around the world suffer from chronic pain. This alteration manifests itself in very different ways, such as headaches, back pain, neck pain, wrist pain... but they all share that it is not known what its organic cause is.

Although the physical cause of these complaints is unknown, most treatments focus on treating the supposed organic cause behind, or at least reduce the perception of pain by 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 find out more about this interesting psychotherapy.

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What is pain reprocessing therapy?

Chronic pain is the reality for many people. It is not difficult to find someone who suffers from pain in his back, neck, has Headaches or feel like he is suffering from a repetitive strain injury, discomfort that flares up every time he has to do certain easy and painless activities for most, but for this type of patient it can become a great suffering.

Not a few people feel that their body aches for no apparent organic cause after performing a mundane task. For example, there are people who start to hurt their back when they have been walking for a while, their neck after sitting for several hours in the office or their wrist from typing.

These same people have gone to various specialists who all have answered the same thing: they cannot find the organic cause. Of course, the treatment is organic, resorting to 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 an interpretation of the brain of the signals it receives from different parts of the body. It is the body's warning signal that alerts the brain that there is some damaged tissue or organ.

Nevertheless, in the case of chronic pain, this signal is a misinterpretation of the brain 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, the techniques of neuroimaging that have been used to address what happens in the brains of chronic pain patients 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."

What about chronic back pain, neck pain, fibromyalgia symptoms, repetitive stress injury, pain in head and other forms of chronic pain are not the result of structural causes but psychophysiological processes 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 who have seen that this type of pain is can reverse. This is where pain reprocessing therapy comes in

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How is it used in patients?

Alan Gordon's group has developed a treatment called pain reprocessing therapy or TRD (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 proper techniques.

Pain reprocessing therapy includes various psychological techniques that retrain the patient's brain to respond appropriately to safe body signals and thus break the cycle of pain chronic.

These techniques include somatic tracking., which combines Mindfulness, reassessment of safety and induction of positive affect. The purpose of somatic monitoring is to help patients see their pain sensation through a different, safer view, and thus attempt to deactivate the pain signal.

As discussed earlier, patients with chronic pain often develop conditioned responses. That is, your brain establishes associations between certain physical activities and the appearance of pain (p. eg, 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 activities themselves without pain.

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Scientific evidence on its effectiveness

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

This study, carried out by Yoni K. Ashar, Alan Gordon, Tor D. Wager and colleagues found that about two-thirds of chronic back pain patients who underwent a four-week psychological treatment based on this therapy felt no or no pain after receiving this treatment. And the most surprising thing is that most maintained the 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 due to mainly to unknown body problems, an idea on which most of the treatments were based to reduce this pain. Unlike classic treatments, aimed at reducing the supposed source of pain, TRD is based on the premise that the brain can produce pain in the absence of an injury or after it has healed, and that people can unlearn that pain.

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

As we have already commented, the 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 acute pain.

In her study, Wager and colleagues recruited 151 men and women who had 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 the treatment, specifically functional magnetic resonance imaging (fMRI) scans to measure how your brain reacted to a pain stimulus mild.

After treatment, 66% of the patients in the treatment group had little or no pain. felt, compared with 20% of the group that received the placebo and 10% of the group without treatment. When people in the PRT group were exposed to pain and evaluated by neuroimaging after treatment, brain regions associated with pain processing, including the anterior insula and anterior median nerve, had become significantly quieter.

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 are not known. have been observed in other treatments, with a durability and magnitude of pain reductions that are very rarely seen in trials with 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 did not consider that this is effective for what is known as secondary pain, which does have its origin in an injury or disease sharp. Wager's study specifically focused 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 limited 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 going well, understanding that it is not. it should be perceived as a danger sign and unlearning pain is a good tool to improve the quality of life of patients.

Pain reprocessing therapy holds great promise as a potentially powerful option for people with chronic pain who want to live free of this discomfort.