Chronic Pain Treatment Focuses on Retraining the Brain to Manage Emotions

A groundbreaking study led by the University of New South Wales and Neuroscience Research Australia (NeuRA) has demonstrated that targeting emotional processing can be an effective strategy for managing and treating chronic pain. The research, published in JAMA Network Open, involved a randomized controlled trial that explored the impact of an innovative therapy called Pain and Emotion Therapy (PET), designed to retrain the brain in emotional regulation.

Chronic pain, which persists for over three months and affects approximately 30% of the global population, not only inflicts physical discomfort but is also strongly linked to mental health issues such as depression and anxiety. Up to 80% of individuals with chronic pain experience these mental health challenges, and their risk of suicide is two to three times higher than the general population. The study emphasizes that persistent pain disrupts the brain's emotional circuitry, leading to emotion dysregulation that exacerbates the pain experience.

The trial, conducted from March 2023 through September 2024 with 89 participants, focused on enhancing emotional processing through a series of group-guided sessions delivered via telehealth across Australia. Participants utilized a dedicated app and workbook for self-guided learning. Those receiving the therapy experienced significant improvements, including better emotional regulation and a reduction in pain levels—equivalent to a 10-point decrease on a 100-point pain scale—maintained over a six-month follow-up.

Prof. Sylvia Gustin explains that this approach is not merely about temporary pain relief but can lead to long-lasting improvements in quality of life. "By changing how we manage emotions, we influence the perception of pain itself," she states. The therapy aims to help individuals de-escalate negative emotions and foster positive ones, thereby interrupting the vicious cycle of pain and emotional distress.

Chronic pain often involves a complex interplay between physical and emotional factors. Traditional treatments rely heavily on medication, including opioids, which can have significant side effects, dependency issues, and diminishing efficacy over time. Psychological therapies, while beneficial, historically have not targeted emotional regulation as a core element. PET introduces a novel focus on emotional skills enhancement as an integral part of pain management.

Participants like Jabez Allies, who has suffered from chronic back pain for a decade, report that emotional regulation strategies help reduce the intensity of their pain. Richard Beaumont, with 11 years of cancer-related and lower back pain, noted that he could lower his pain from a 9 to a 4 or 5 just by calming his emotions.

The therapy works by teaching patients to identify, acknowledge, and regulate negative emotions, recognizing their role in pain amplification. Dr. Nell Norman-Nott underscores that chronic pain often involves the suppression of negative emotions and the difficulty in recognizing positive emotions. The therapy encourages individuals to express and resolve these feelings, promoting a healthier emotional state.

Accessibility is a key advantage of PET. Delivered online, it reduces barriers related to mobility, social anxiety, and geographic location, making treatment available to remote and regional populations across Australia. This mode of delivery is especially critical given the long wait times and limited access to specialized pain management services outside major cities.

The researchers are now planning larger clinical trials to further evaluate the therapy's efficacy. The initial results highlight the importance of treating both the physical and emotional aspects of chronic pain, marking a significant shift in pain management paradigms.