A common injury for which people seek physical therapy in Boulder, Colorado is back pain. In fact, low back pain leads globally in years lived with disability, having increased by over 60% between 1990 and 2017 despite an increase in research and money spent on treating it.1,2
In 2021, a randomized clinical study was conducted to assess the response of individuals with chronic low back pain to a treatment called Pain Reprocessing Therapy (PRT).3 PRT is a psychological intervention that emphasizes that the brain can create pain in the absence of tissue damage and that teaches the participant to reappraise their thoughts about pain, thus decreasing the perceived threat of the sensation.
Study Design: The patients who participated in this randomized clinical study were in Boulder, Colorado. Their mean age was 41.1 years, they had been in pain for an average of 10 years, and they had at least a 4/10 pain level. 151 participants were randomized into 3 groups: The PRT intervention group, a placebo (saline injection) group, and a usual care group that did not make any changes. The PRT group participated in 9 sessions over 4 weeks that focused on reconceptualizing the pain.
Outcomes: After 4 weeks of treatment, the PRT group reported the most reduction in pain, with a mean pain level of 1.18/10. This was largely maintained at the 12-month follow up. The participants also had and maintained a reduction in depression, anger, and disability, and an improvement in sleep. MRI of the brain also showed decreased pain-related activity of the brain following PRT treatment.
Discussion: The authors conclude that “Changing fear- and avoidance-inducing beliefs about the causes and threat value of pain may provide substantial, durable pain relief for people with primary chronic back pain.”
If you have back pain, you may benefit individualized physical therapy with Dr. Sarah Burkhardt.
or email sarah@seatosummitpt.com with any questions!
For more about pain and the brain, see this blog About Pain, and this one about a variety of symptoms and the Autonomic Nervous System. To learn more about the ability to function without pain, even in the presence of MRI pathology, read about these rock climbers here!
- Wu A, March L, Zheng X, Huang J, Wang X, Zhao J et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the global burden of Disease Study 2017. Annals of translational medicine. 2020;8(6). ↩︎
- Leininger, B.D., Kuntz, K.M., Hodges, J.S. et al. Cost-effectiveness of spinal manipulation, exercise, and self-management for spinal pain. Chiropr Man Therap 33, 36 (2025). https://doi.org/10.1186/s12998-025-00599-8 ↩︎
- Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13–23. doi:10.1001/jamapsychiatry.2021.2669 ↩︎