
CAN BRT HELP MY PATIENTS?
in 2019, the World Health Organization (WHO) introduced chronic primary pain (CPP) as a new diagnostic category in the 11th revision of the International Classification of Diseases (ICD-11)
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This new diagnosis acknowledges that pain is a disease in its own right, rather than just a symptom.
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80% of chronic pain is chronic primary pain. Chronic pain is epidemic throughout the world. In the US alone 50 million people suffer from it.
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CPP is pain that is caused when the brain misinterprets signals from the body. It is not caused by tissue or skeletal damage.
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It calls for a completely different approach to the treatment of chronic pain.
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Numerous studies have supported this new conceptualization of chronic pain, showing among other things that chronic primary pain is experienced in a different part of the brain than acute pain.
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Primary chronic pain is a learned response that occurs when a sensation becomes linked to fear.
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The good news is that the brain is neuroplastic meaning that it can learn how to rewire itself and unlearn the chronic primary pain response.
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BRT aims to address chronic primary pain, which is thought to be the most common cause of chronic pain and results from the brain misinterpreting safe signals from the body as dangerous.
Neurobiological research shows that the brain can generate pain even in the absence of physical damage. This is often noted to be the case in individuals who had an injury that has since healed or others who may not have identifiable physical damage at any time. BRT aims to eliminate pain by retraining the patient's brain to accurately interpret and respond to signals from the body.​
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What evidence supports the effectiveness of BRT approaches?
In 2021, a major study at the University of Colorado Boulder found that Pain Reprocessing Therapy (PRT) (a BRT approach) is an effective treatment for chronic pain. Patients with chronic back pain were randomly assigned to one of three groups: PRT, treatment as usual, or an open-label placebo injection. After four weeks of treatment, 98% of patients in the PRT group reported improved pain, and 66% were pain-free or nearly pain-free. The pain reductions achieved through PRT were largely maintained even a year after treatment.
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This is the first of many evidence-based studies that have further demonstrated the effectiveness of PRT and other similar approaches. ​​​​​
For more evidence, click here.
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What is neuroplastic pain aka chronic primary pain?
This video does a great job of explaining how neural networks cause neuroplastic chronic pain.
The WHO determined that 80% of chronic pain is primary chronic pain.
Your patients/clients may have neuroplastic pain if:
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Their pain began during a time of stress
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Their pain originated without injury
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Their symptoms are inconsistent
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Their symptoms spread/move around your body
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They have a large number of symptoms
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Their symptoms are triggered by stress
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Their pain is triggered by factors that have nothing to do with your body (weather, sounds, smells, time of day)
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They have symmetrical symptoms (same part of body on both sides)
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Their pain has a delayed start after movement/exercise
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They experienced childhood adversity/trauma
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They are perfectionistic, conscientious, a people pleaser, or highly anxious
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They lack a physical diagnosis
Can BRT still benefit my patients if their pain is caused by a physical issue or disease?
BRT can treat “mixed pain”, where a client presents with both structural and primary chronic pain(PCP) symptoms. For example, MS or cancer (not CPP) and tension headaches or anxiety (CPP). With all chronic symptoms, there is usually an added layer of suffering due to fear, anxiety, body preoccupation, and amplification of physical sensations beyond what is being caused by the structural issue alone.
BRT concepts benefit everyone, and there is no harm/risk in incorporating a mind-body perspective, so long as patients still receive necessary medical interventions for their non CPP issues.
Does BRT work for chronic physiological symptoms besides pain?
Yes! Any unpleasant or undesired sensation, including irritable bowel syndrome, weakness, fatigue, nausea, dizziness, tinnitus, insomnia, and more, can fall under CPP. To reduce/eliminate these symptoms, BRT can help your patients learn to interpret sensations correctly and through a lens of curiosity, interest, and safety.
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