New article on "Pain Reprocessing Therapy"

hapl808

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Looks to me like CBT just with better branding.

It's an open label placebo controlled trial. In other words, the placebo recipients were told they would be injected with a saline placebo. So psychotherapy is better than being stabbed in the back with a needle? I know all the research on open label placebos and I'm highly skeptical of their use in this scenario and why they wouldn't have just used a sham therapy.

"Pain Reprocessing Therapy (PRT) has five main components: 1) education about the brain origins and reversibility of pain, 2) gathering and reinforcing personalized evidence for the brain origins and reversibility of pain, 3) attending to and appraising pain sensations through a lens of safety, 4) addressing other emotional threats, and 5) gravitating to positive feelings and sensations."

So basically they're repackaging all the alternative limbic retraining, Gupta DNRS, etc. How is this any different?

I tried DNRS - because why not. Did absolutely nothing as far as I could tell.

Seems like a great way to insist on CBT (by whatever name) despite all the evidence that shows it's useless for most of these things.

I don't suffer from severe pain and I'm open to different management techniques, but their incredibly good results make me incredibly suspicious.

I could go on, but I think it's a load of repackaged crap. Not even fresh crap.
 

wabi-sabi

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There's just so much wrong with this study it's hard to know where to start. Basically, it involves convincing people that their pain isn't as bad as they think it is. I've never found that really effective on my pain.

If you're more cognitively able than I am right now, you might look for their data for one year follow up. As far as i can tell, they say their primary outcome was a pain questionnaire 1 month after the intervention. But they also claim in the abstract that the pain reduction was durable for a year. I can't find evidence for that in the paper anywhere.

On the whole, I think their hypothesis on how pain works is wrong. Beliefs just don't generate illness in this way- this is some really powerful magical thinking on the part of the experimenters. If the treatment worked, and it's hard to figure out based on their measures, I'm not sure why can say why it worked.
 
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Second star to the right ...
I could go on, but I think it's a load of repackaged crap. Not even fresh crap.
Yeah. What @hapl808 said.


It's getting so I can almost predict when this kinda ...... uhhhh .... stuff, and all it's newly discovered little useless (and usually expensive) cousins, is going to pop up. There's a definite rhythm to it: when the Lightning Process gets booed out of the room, Gupta resurfaces again, when that gets rotten tomatoes, DNRS makes another appearance, when that gets The Hook, something "new", which is actually a rebranded, reworked, same-old/same-old is hoisted onto the stage.
 
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There's just so much wrong with this study it's hard to know where to start. Basically, it involves convincing people that their pain isn't as bad as they think it is. I've never found that really effective on my pain.
Totally agree @wabi sabi ..... also, love your dry, wry humor re the treatment's focus ....
On the whole, I think their hypothesis on how pain works is wrong. Beliefs just don't generate illness in this way- this is some really powerful magical thinking on the part of the experimenters.
Totally, totally, TOTAAAAAALLY :aghhh::aghhh::aghhh::aghhh: :D....
 

wabi-sabi

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also, love your dry, wry humor re the treatment's focus ....
Well, humor does help to deal with the madness.

I wish I weren't so brain dead and could explain better, but I really feel that a lot of this over emphasis on the power of the mind comes from a fear of illness and fear of the body. Chronic illnesses are terrifying- watching your body fall apart and feeling the consequences. It's very tempting for researchers (based on the inordinate amount of research in this direction) to try to get away from that fear by believing the mind has power to control what's going on in the body. If only I think about the illness in the right way, it will lose it's power over me. Unfortunately, that's just not how illness works.

That's not to say that conceptualizing our illness differently can't relieve some of the suffering- it can. And mind-body modalities like meditation, guided imagery, etc., can give you respite from pain. But respite from pain through prayer or meditation is very different from CBT that aims to convince you that the pain is just a malfunction of the mind, and if you got your mind in order it would go away. That's magical thinking, which just sadly isn't real.
 

wabi-sabi

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Ooh, I just thought of something- a lack of healthy controls. We want to compare the power of the intervention to effect change in the brain right? and yet we are only looking at people whose brains (may) have been damaged due to chronic pain. That doesn't really give a good picture of brain function. I want to see how healthy people respond to this intervention and if their MRI scans change or if their beliefs change in response to the CBT.
 

hapl808

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I want to do a open label placebo controlled trial of my new snake oil. The placebo will be two smacks in the head with a baseball bat, and patients will be told the baseball bat is a placebo. I expect my snake oil to be a runaway clinical success. Or a slither away clinical success, as the case may be.

"Patients in the treatment arm showed fewer cluster headaches and significantly (p<0.05) less blunt force trauma injury. Primary endpoints (changed three days before the end of the trial after a night of heavy drinking) were met and most of the snakes were recovered." Olaf et al
 
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The study struck me as inadequate, especially small sample size; skewing to white educated population with low intensity pain, most still able to exercise several hours each week; lack of healthy controls; open-box placebo. I just wanted to know if anyone had had this treatment recommended to them and maybe tried it.
 
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