Change in Pain-Related Anxiety Mediates the Effects of Psychophysiologic Symptom Relief Therapy (PSRT) on Pain Disability for Chronic Back Pain: Secondary Results from a Randomized Controlled Trial

Abstract

Bethany D Pester,1,2,* Jolin B Yamin,2,3,* Maria J Cabrera,2,3 Shivani Mehta,2,3 Jeremy Silverman,2,3 Anne V Grossestreuer,2,3 Patricia Howard,2,3 Robert R Edwards,1,2 Michael W Donnino2,3 1Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Michael W Donnino, Center for Resuscitation Science, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Rosenberg 2, Boston, MA, Boston, USA, [phone], Email [email protected]: Widely used therapeutic approaches, such as cognitive-behavioral and mindfulness-based therapies, can improve pain and functioning in people with chronic back pain, but the magnitude and duration of their effects are limited. Our team developed a novel 12-week program, psychophysiologic symptom relief therapy (PSRT), to substantially reduce or eliminate pain and disability. This study examined whether PSRT helped more patients achieve large-magnitude (≥ 30%, ≥ 50%, ≥ 75%) reductions in back pain-related disability compared to mindfulness-based stress reduction (MBSR) and usual care (UC), and if the beneficial effects of PSRT were explained by reductions in pain-related anxiety following treatment.Patients and Methods: Data from a three-armed randomized controlled trial were used (N=35 adults with chronic back pain). Change scores (baseline to 4-, 8-, 13-, and 26-weeks post-enrollment) were computed for back pain disability (RDQ) and pain-related anxiety (PASS-20). Fisher’s exact tests and mediation analyses were conducted.Results: Compared to MBSR and UC, PSRT helped significantly more patients achieve ≥ 75% reductions in back pain disability at all timepoints and in pain anxiety at all timepoints except 13-weeks. Change in pain anxiety significantly mediated the relationship between treatment group and change in back pain disability from baseline to 26-weeks.Conclusion: PSRT helped more patients achieve substantial reductions in disability than an established treatment (MBSR) and usual care. Findings indicate reduced pain anxiety may be a mechanism by which PSRT confers long-term benefits on disability. Importantly, this work aims to move the field toward more precise and effective treatment for chronic back pain.Keywords: chronic back pain, mind-body therapies, back pain disability, pain-related anxiety

Keywords

• chronic back pain
• mind-body therapies
• back pain disability
• pain-related anxiety