Background & Aims

Chronic pain, often lacking clear organic causes and recognized as nociplastic by the International Association for the Study of Pain, frequently coexists with PTSD and various mental health disorders, highlighting the urgent need for more effective treatments.

Advancements in understanding neural threat signal processing and brain neuroplasticity have been pivotal in recognizing psychological therapies as potentially transformative in managing and reversing chronic pain. (1,2) Emerging approaches that integrate neuroscientific findings with somatosensory experiences and mindfulness practices are promising for long-term pain relief and recovery (3). These newer methodologies, particularly in an accessible online format, are reshaping the landscape of chronic pain treatment.
This research aims to evaluate the effectiveness of our online group intervention in reducing symptoms of chronic pain, and mental health conditions, while also examining the underlying mechanisms.

Methods

To validate our intervention, we carried out two empirical studies on chronic pain patients, excluding those with cancer-related and neuropathic pain (N=39 and N=149). The initial study included 19 participants and a 20-person waiting list control, with evaluations at three stages: pre, mid, and post-intervention. Following this, a Randomized Controlled Trial (RCT) with Ukrainian participants was conducted, maintaining similar exclusion criteria and incorporating a PTSD self-assessment. This RCT involved assessments at four intervals: before, during, immediately after, and six months post-intervention. Participants on the waiting list in both studies received the intervention recordings afterward. The intervention entailed an 8-week online program with biweekly 2-hour sessions, enhanced by intensive chat support and self-training exercises. It integrated personalized psychoeducation, coaching, mindfulness, and somatosensory awareness, specifically designed for chronic pain management.

Results

Results from both studies consistently showed that our intervention notably decreased pain, (both p’s<0.001), depression (study 1: p=0.04; study 2: p=0.003), and anxiety (both p's<0.001), improved functional abilities (both p's<0.001), and enhanced life quality (both p's<0.001) compared to the control group in individuals with nociplastic chronic pain. These outcomes were clinically significant for at least six months. Furthermore, mediation analysis suggested that the fear of pain (p<0.001) and perceptions about pain sources (p<0.001) could be key factors influencing the intervention's success.

Conclusions

Our study emphasizes the effectiveness of a novel online intervention in managing nociplastic chronic pain and related mental health conditions. Integrating personalized psychoeducation, mindfulness, and coaching techniques, this approach not only demonstrates clinical efficacy but also highlights the potential for increased accessibility and scalability in chronic pain management and treatment.

References

1. Markfelder, T., & Pauli, P. (2020). Fear of pain and pain intensity: Meta-analysis and systematic review. Psychological Bulletin, 146(5), 411–450. https://doi.org/10.1037/bul0000228
2. Hashmi, J. A., Baliki, M. N., Huang, L., Baria, A. T., Torbey, S., Hermann, K. M., Schnitzer, T. J., & Apkarian, A. V. (2013). Shape shifting pain: Chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain, 136(9), 2751–2768. https://doi.org/10.1093/brain/awt211
3. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients with Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669

Presenting Author

Pavel Goldstein

Poster Authors

Pavel Goldstein

PhD

University of Haifa

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Nociplastic and chronic widespread pain