New insights into chronic pain following recent research

by Lauren Haas, a serious injury lawyer at Irwin Mitchell

As part of my work as a solicitor representing injured people of all ages and sizes and genders, amongst which are clients suffering with severe or multiple injuries, it has always been of professional interest to me to read any research on chronic pain and I recently came upon a most interesting new study. The peer-reviewed US American study in question approaches chronic pain as a mind and body issue. 

The study can be found at the bottom of this article, having been published in JAMA Psychiatry and is a University of Colorado investigation into chronic pain with the title “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain - A Randomized Clinical Trial”.

Pain reprocessing therapy

The US authors were aiming to test a new treatment called “pain reprocessing therapy” (PRT) as the potential solution to ongoing chronic back pain by “aiming to shift patients’ beliefs about the causes and threat value of pain provides substantial and durable pain relief from primary CBP and to investigate treatment mechanisms.” 

The key question which the study researches is therefore whether a psychological treatment such as PRT can provide substantial and durable pain relief. PRT was pioneered by Alan Gordon, who is director of the Pain Psychology Center in Los Angeles and it is designed to teach patients to re-evaluate pain as a neutral sensation coming from the brain, rather than as evidence of a dangerous physical condition. The theory is that - as patients come realise that their pain is uncomfortable but not physically threatening - the brain in turn “resets” and rewires the neural pathways which cause the pain signals improving the pain level.

The study included 3T MRIs and 1 year follow up assessments in a randomised clinical trial from November 2017 to August 2018 with the 1 year follow up completed by November 2019. It assigned randomised equal percentages of patients to either PRT, placebo treatment or more conservative treatment within the community. Fascinatingly, the study showed that of 151 total participants, 33 of 50 participants (66%) allocated to the PRT were pain-free or nearly pain-free at the end of the treatment with only 10 of 51 participants (20%) of the placebo patients and 5 of 50 participants (10%) in the usual community care setting reporting the same levels of reduction. Even more overwhelmingly, 88% of patients assigned to PRT had experienced at least some benefit and this was the case even a year later during the follow up sessions. 

My (no doubt very simplistic) takeaway from the study is that, much like an immune system overreacting in certain autoimmune conditions, it seems the brain too can overreact and misinterpret signals which in turn causes the subjective sensation of pain despite there being no organic or structural cause of that pain. It is almost like a switch is permanently turned on in the brain which interprets certain signals wrongly. In the same way that we may experience an elevated heart rate to perceived danger or a blush in reaction to what is perceived to be an embarrassing situation, the brain and body therefore cause a chronic pain reaction. It is thus not simply “in the head” of the person experiencing pain.

Chronic pain and the issue of causation in legal claims

The issue of chronic pain in legal cases can be one of the most difficult issues to deal with. Readers may recall that when making a personal injury claim, whether following a road traffic accident, accident at work or any other type of accident, it is for you as a claimant and therefore the party making the claim to establish your case and prove it. This means proving that the party the client is claiming from was negligent and in turn that this negligence caused the harm a client has suffered.

In claims involving chronic pain, the challenge is usually proving that the accident in question caused the client’s symptoms to develop and that the extent of such chronic pain symptoms was caused by the accident. 

Due to the nature of litigation, a defendant may try to discredit or undermine the extent of a client’s injuries or try and argue that that what the client is experiencing is not related to the injuries they suffered in the accident (particularly, I find, if the client is suffering from pre-accident mental health issues).

Insights which the study provides on point of legal causation

One of the real struggles which I experience most clients with chronic pain conditions as experiencing is their fear of not being believed, that they are in some way making things up or that the pain is solely in their head with all the stigma this (still) carries with it. This is especially so if an MRI or other imaging shows no definitive structural or organic cause for pain.

The US study in question clearly and helpfully shows that chronic pain can undoubtedly be something developed by the neurons in your brain as a reaction to an injury and at its most simplistic reflects the connection between the brain and the body not working. It must therefore be treated as a mind-body combination, rather than one or the other.

The study also, and perhaps most importantly, shows that such chronic pain can be reversible. In what another study author calls a “neuroplastic” approach, pleasingly chronic pain does seem react to a bespoke and nuanced treatment such as PRT. This alone makes it worth pursuing further research into treatment, in the hope that my future clients benefit from chronic pain treatment with the same consistently high recovery rates as, say, treating a fracture in a plaster cast. 

Whether we will see PRT in the UK in perhaps quite the same form is questionable, but there is no question this or a similar approach must and should be included in mainstream treatment of chronic pain in the same way that a painkiller injection or tablet would.

Find out more about Irwin Mitchell's expertise in supporting people following injury at our dedicated serious injury section.