Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain an RCT, 2021, Asher, Gordon et al

excellent find! I had just glanced over the text. the difference in cannabis use is the most striking. but it's not clear from the table what period of time is being discussed. 7g of cannabis is a lot.

 

Its not very meaningful @Daisybell. They started with 16 regions of interest - that is, they went in with 16 chances of finding some sort of difference between their treatment and control groups on fMRI. That's a lot of second chances. They would have needed to correct for multiple comparisons, and I can't see anywhere where they've done this. The the p values they reported are large and none would survive even a gentle correction.

Even if the differences were reliable, it would still be almost impossible to interpret what they mean about mental functioning. Regions like the anterior midcingulate cortex and the anterior PFC have been associated with a lot of different tasks and situations, and we still don't fully understand what exact roles these regions play in supporting our overall cognitive function. There's a lot of hot disagreement in the literature. So, we're nowhere near the position of being able to say "Oh, yes, that reduced activation there in region X means that the person is doing Y". It just doesn't work like that.

You can't work backwards like that, you need to start by committing yourself to one or two carefully chosen predictions, and then see if they pan out. One reasonable prediction you could make is that this pain reprocessing therapy might lead to better top-down control over pain, so we should expect to see greater anterior PFC activity in response to evoked pain than in the control group (that's what a lot of placebo pain studies claim to have found), These researchers found the opposite. But they seem to think that whatever way the data goes, it somehow supports their conclusions - heads we win, tails you lose Obviously, that's just cheating

 

i am surprised you are surprised.

This is what is happening here for ME. And in fact for Long-COVID clinic, which seemingly exist ‘to reassure the patient’- they are then streamlined into self-management and education programs.

The chronic pain program is also based on BPS, minimizing contacts with the drs and maximizing on BPS and self-management.

All the programs mentioned mention you have to be committed in your own recovery. (IE Acceptance and Commitment therapy)

 

That the differences were present at baseline, rather than emerged with treatment, seem important here.

Also, I know it's meant in a jokey way, but talking about the brainwashing group could be an unhelpful habit for discussing research like this, especially if people are also reaching out to researchers on twitter.

 

'Brainwashing' also comes from cold war paranoia and it seems questionable that the original understanding of 'brainwashing' is something that is even possible. If it is, it seems it would need more extreme measures than occur within the NHS. There's also a history of people using 'brainwashed' to dismiss those who have been persuaded of things that the accuser dislikes.

Changing people's beliefs isn't necessarily brainwashing - we've all tried to change other peoples' beliefs, and had our own beliefs changed by others. There's a spectrum between reasoned persuasion and dishonest manipulation. If we have a culture where patients concerned about some of the specifics around CBT (or any therapy that intends to change patient beliefs) casually refer to that as brainwashing then I expect that's more likely to create confusion than be helpful.

 

I've been reading about the main author of the study and his clinic in Los Angeles, that is Alan Gordon, LCSW. and his Pain Psychology Center.

Gordon is associated with Dr. Harold Schubiner (mind-body medicine) who believes that stress explains exactly everything and who is also an author of the chronic back pain study referenced above.

My conclusion is that the study was essentially a marketing ploy.

The power of suggestion, using psychotherapy and relaxation to lower the subjective experience of pain is all well and good. But not to blow this out of proportion and make it into a cult. Again, this is the USA and anything can be made into a $$brand$$. Looks like we'll be needing David Tuller soon on the homefront.

PS I would love to get rid of my fibromyalgia by talking pretty to my brain, were it that simple-minded.

 

Here is where the research took place: at the Cognitive and Affective Neuroscience Lab at the University of Colorado-Boulder.

https://www.colorado.edu/asmagazine/2019/08/30/it-possible-think-pain-away

Fairly outrageous claims about near extinguishing of pain in 4/5 of patients. I would guess that many of the "saved" had low levels of residual pain.

I want this to be true, truly I do.

 

Found this thread again. I posted about a brain training websites that is now selling their services. Thread here: https://www.s4me.info/threads/brain-retraining-online-programs.24102/

in which way can the authors claim that injecting sterile water subcutaneously represents a placebo treatment?

Typically, if your treatment of choice is psychology based, wouldn’t the placebo control be a sham psych ie: sitting in a group and say Hom for an hour?

I was trained to give sterile water injections in the back as a registered nurse (we got an inservice and practiced on each other, we never put it in practice for our patient population) and when i played the patient for a nurse to practice, i could not complete the 4 injection sites, it was so painful. i would not qualify that as placebo to the brain washing treatment.

 

Completely unsurprisingly, Paul Garner has today tweeted a link to this study, commenting
"Great RCT in JAMA. Changing beliefs cured chronic backpain. Pain and fatigue neural networks overlap: I am sure the belief that #longcovid fatigue is biomedical reinforces the symptoms"

 

OK, so I can believe that in some cases carefully pushing through back pain can be beneficial - I've done it myself. Some back problems benefit from gently using your back, even though it can hurt and is uncomfortable, and a bit scary; it has helped me get over some issues.

But - what has that got to do with Long Covid?

 

I think PG has simply lost the plot. Everything he says to somehow try and assert his eminence just demonstrates the complete opposite. I find him a bit sad really.

 

The actual differences on the scales between the groups were actually quite small, around 1 point on a 1-10 point scale, for example. This is very consistent with a difference in questionnaire answering behaviour, rather than underlying health. (combined with a regression to the mean/natural recovery across all groups)

Most of the fMRI findings were not consistent - they'd have to be found for both the treatment-as-usual and 'open label placebo' groups for it to be valid.

 

Just stumbled (again) across the Psychophysiologic Disorders Association (PPDA) and how they use their[*] study discussed here as "proof" to promote their hypothesis and treatment recommendations for a "mindbody approach" -- and are proud that the 'UnitedHealth' Group seem to be interested in their expertise.

Now saw that it was already discussed here:

And thought I'll add the text of the screenshot and leave some links here, both to forum threads and other links.

Text from the screenshot posted by Hutan:

Changing the healthcare paradigm

"UnitedHealth Group, the world’s largest healthcare company, asked PPDA Co-Founder Dr. Howard Schubiner to consult on model pain clinics with a team of physicians, physician’s assistants, nurse practitioners, physical therapists and mental health providers, all trained in mindbody medicine. Christie Uipi led the behavioral health team.

"It’s incredibly exciting and challenging to put our ideas into a real-world clinic, and this wouldn’t have happened without the support of PPDA donors who helped us to sponsor the clinical trial (above).

https://ppdassociation.org/about

More links:

"The Boulder Back Pain Study - Proof that a psychological approach can cure chronic pain"

https://mytmsjourney.com/resources/...psychological-approach-can-cure-chronic-pain/


....and in the UK:

They are also supporters of the SIRPA conference (SIRPA = "Stress Illness Recovery Practitioners’ Association, the first group in the UK & Europe to adopt the TMS approach to chronic pain") :

https://www.sirpaconference.com/supporters/

SIRPA website:
https://www.sirpa.org/


More about Schubiner who's both on PPDA's board of directors and acts as SIRPA's research adviser:

[*] From PPDA's website:

"Thanks to many of our donors in 2017, we were able to sponsor the first randomized controlled trial showing that chronic back pain can not only be managed, but can be CURED using a mindbody approach. And the study was published in JAMA Psychiatry, one of the top medical journals!

"PPDA Co-Founders Alan Gordon and Dr. Howard Schubiner along with Dr. Yoni Ashar, Christie Uipi and Dr. Tor Wager led the study at the University of Colorado Boulder."


Edited to remove confusing link to related topic but different persons and organizations.

 

Not sure if this was already captured -- from the PPDA's 'About' / Leadership :




https://ppdassociation.org/about/#leadership

 

Oh. And the the PPDA's president and co-founder David Clarke is medical advisor of the UK enterpise "Living Proof", founded in 2022 by someone who describes herself as recovered from ME/CFS after "she learned about the mindbody approach from a Buddhist nun, and started to understand that her symptoms were directly related to recent significant stresses [...]"

"[Penny George] made a rapid recovery, left the job and has worked ever since to help others understand there is hope of recovery."

Living Proof's mission is ...

"To promote widespread understanding and application of the mindbody approach to health among practitioners, patients, and the general public".

https://www.livingproof.org.uk/our-team

Surprisingly, 'Living Proof' also refers to the Boulder back pain study, claiming:

"What is new, however, are emerging studies which show that we can actually reverse chronic pain and other misunderstood symptoms through applying techniques which calm the nervous system, and help us process our repressed emotions.

"For example, two studies were published in September 2021 that both independently demonstrated that a mindbody approach is a highly effective treatment for chronic back pain. "