‘More than just ouch’: Emotional therapy treatments for chronic pain found effective
Training emotional regulation in chronic pain sufferers could be as effective as surgical intervention or medication, Australian research shows, as particpants deliver demonstrably effective outcomes.
Emotional therapy is an effective and highly accessible form of chronic pain relief, research has proven, as the medical industry re-evaluates rampant use of opioid medication and surgery.
Despite the persistent rise in reports of chronic back pain, clinicians and orthopaedists are increasingly shying away from the use of painkillers, citing concerns of patient resistance and dependence, along with surgical interventions such as shrinking disks, melting nerves or spinal fusion.
A new study teaching participants to focus on positive emotions and abate negative feelings associated with their pain has delivered demonstrably effective outcomes, providing a treatment with little personal cost or risk.
The collaborative study headed by UNSW and Neuroscience Research Australia (NeuRA) pioneered a specially designed style of treatment dubbed Pain and Emotion Therapy.
A digital health treatment, it uses online clinical sessions to retrain emotional processes involved in minimising or catastrophising pain.
Results after six months were significant, with subjects reporting better emotional regulation and a 10 per cent pain reduction. This was gauged through self-assessment.
Alongside presenting a lucrative market, chronic pain has a debilitating impact on productivity when untreated. It is currently estimated to carry an economic impact higher than the sum total of other chronic conditions like heart disease, cancer and diabetes combined.
Trial participant Janelle Blythe has endured 30 years of chronic pain but was able to begin tapering her morphine usage for the first time after taking up the experimental therapy.
“I’ve been on a lot of opioids and things like that, but I’ve found no course that’s been able to help take away the pain or help control the pain at home. Having chronic pain is very emotional and very stressful, so doing this course was good and I’ve not really found anyone that’s cared about my emotional side of my chronic pain,” Ms Blythe said.
“The more emotional you are, the more pain you have, which is a bit weird, but that’s the way it is.
“I’ve tried to reduce my morphine for 30 years because otherwise you’re on it and your (dosage) just goes up and up and up. I’ve been able to bring it down with very little help apart from the course.”
The results collected by NeuRA and UNSW study leads Nell Norman-Nott and Sylvia Gustin were published in the Journal of the American Medical Association on Wednesday. Dr Norman-Nott argued that chronic pain among patients had become infectious by virtue of it being expected and worsened by negative emotions.
“We’ve known now for some time that chronic pain is more than just ‘ouch’. It’s more than a sensory experience, it’s incredibly emotional,” she said.
“The focus on training for emotional regulation appears to be the missing piece of the jigsaw puzzle of chronic pain treatment.
“We’ve gone from purely medical and biological approaches to a more holistic treatment model that includes addressing social and psychological experiences. Opioids … present considerable issues with dependency and declining effectiveness.”
The study’s 89 participants took part in group therapy sessions over video calls for a year and a half, supplementing their learning with handbooks and a guided app.
Its tailor-made Pain and Emotion Therapy will be expanded upon in a larger trial bankrolled by the Medical Research Future Fund next year.
Professor Gustin said the “inability to regulate negative emotions” was a common symptom among patients whose back pain progressed over time.
“By changing how we manage emotions, it is possible to change the experience of pain itself,” she said. “This is not just a temporary relief but a potential long-term improvement in quality of life for those affected by chronic pain.
“This is disrupted by the impact of persistent pain on the brain’s emotional circuitry. The resulting emotion dysregulation is an ill-understood and under-treated aspect of chronic pain, which we addressed in this trial.”
Chronic pain is correlated with depression and anxiety in 80 per cent of cases. Suicide rates are two to three times higher among sufferers, and women disproportionately suffer more chronic pain.
The study’s outcomes are backed by neurochemistry, with prior studies showing pain causes a drought of gamma-aminobutyric acid (GABA), a natural sedative, in the brain, which in turn causes an emotional spiral and deprives the body of natural pain relief.
“Chronic pain is linked to actual pathological changes in the brain. People living with chronic pain are often stigmatised and are told it’s all in their head, especially when it comes to emotional suffering. This is simply not true, there is a real measurable change happening in the brain,” Professor Gustin said.
“Our research (shows) it actually doesn’t matter which type of pain you have because you emotionally suffer very similarly.”
More Coverage
To join the conversation, please log in. Don't have an account? Register
Join the conversation, you are commenting as Logout