You play a sport, and you get injured.  That’s straightforward, right?  Sometimes it is. You sprain your ankle, x-rays are negative, wear an ankle brace, do some rehab, and you’re mostly healed in three weeks.

But sometimes it isn’t. Sometimes, pain persists in the shoulder, knee, or back, even when the physical therapist or sports doctor says you’re healing “nicely.” They may do X-rays or an MRI scan.  But there’s not much showing up. Occasionally, what shows are “normal abnormalities,” but these do not clearly explain your pain.

I have been treating patients with pain for decades.  Nearly every patient with chronic pain (more than six months of pain) has associated fears. Often, the fear relates to the uncertain future.  Will the pain be resolved?  Will I get worse?   Fear fuels the pain.

In the extreme, it becomes “Will I end up in a wheelchair?” I ask about and listen to these fears. I believe they are crucial in unraveling the pain cycle and moving out of the pain circuit in the nervous system. Too often, these fears relate to prior statements by the health profession. 

In 2017 the PPD Association crowdfunded over $100,000 from over 500 donors in 24 countries around the world. This allowed the Boulder (Colorado) Back Pain Study to expand from two study groups by adding a third group that would receive Pain Relief Psychotherapy.

150 patients who had suffered back pain without signs of nerve damage (such as muscle weakness, loss of reflexes, numbness, bowel or bladder dysfunction) were selected for the study. Back pain duration was an average of ten years. The patients were randomly divided into three groups and treated either with (1) their usual medical care, (2) a placebo (fully disclosed to participants) injection into the spine, or (3) two one-hour sessions of Pain Relief Psychotherapy every week for four weeks.

Neuroplastic psychology has been successfully used to treat patients with Long Covid. Twenty-three adults under the age of 60, averaging nine months of Long Covid symptoms that they described as “High” or “Very High,” were enrolled. Participants received Psychophysiologic Symptom Relief Therapy (a form of neuroplastic psychology) during a 13-week (approximately 44-hour) course.

Adverse Childhood Experiences (ACEs) are traumatic events or circumstances that occur during childhood. They can have significant long-term impacts on mental and physical health into adulthood.

Many people who think about their early years do not fully recognize the magnitude of the adversity they endured. An exercise that can support more accurate understanding of your ACEs is to imagine a child of your own growing up exactly as you did. If you were observing that child, would you feel sad or angry? Would you see anything that might harm a child’s self-esteem or self-worth?

Once you begin looking for psychosocial causes of pain or illness (Neuroplastic Symptoms) in patients, you find it repeatedly. The same is true for research scientists.

A study from the University of Michigan looked at the electronic health records of over 2 million people in three groups: people with Covid, people with influenza, and people with no infection during a routine health appointment. They determined which of these people had a “chronic overlapping pain condition” (COPC) causing widespread pain often associated with fatigue or problems with sleep, memory, or mood. Next, they assessed whether having a COPC predicted a person’s subsequent development of Long Covid.

Mental health apps have been controversial. Do they work for chronic pain?

In a controlled trial from British Columbia, 198 subjects with chronic pain (non-cancerous) for an average of 13 years were randomly given either the app Curable (at no charge) or their usual care. Curable uses a biopsychosocial model aligned with the approach advocated by the ATNS. 

The previous study from this center has been updated with a much larger number of 126 patients to provide even more evidence of the remarkable benefits of Emotional Awareness and Expression Therapy. In this study, the veterans (average age 72 years, 92% male, 55% African American) with chronic musculoskeletal pain were randomized to receive either EAET (Emotional Awareness and Expression Therapy, a form of Pain Relief Psychotherapy) or CBT (Cognitive Behavioral Therapy). CBT is the most widely available form of psychotherapy in the U.S. Both treatments were provided as one 90-minute individual session and eight 90-minute group sessions.  The goal for patients was to achieve at least 30% pain relief.

To understand the importance of a new research paper, you should know that the vertebral bones of the spine have several important functions. They must protect the spinal cord, support the head and upper body, and enable egress of nerves that carry sensation and control muscles. They also need to remain flexible enough to allow freedom of movement. To accomplish all this, the vertebra has a complex yet marvelously esthetic structure that includes two wing-like bones called facets. They connect to the main vertebra via a small joint.