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What's New in the Field of TMS/Neuroplastic Pain

Research during  2019-26:

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Pain Reprocessing Therapy (PRT) Studies

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1. 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

• Landmark study: 66% of patients pain-free or nearly pain-free after 4 weeks of PRT

• Results superior to both placebo injection and usual care

• Brain imaging showed reduced pain processing in key brain regions

2. Ashar YK, Low EL, Knight K, Schubiner H, Gordon A, LeRoux A, Lumley MA, Wager TD. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025;82(10):1049-1051. doi:10.1001/jamapsychiatry.2025.1844

• Five-year follow-up demonstrates sustained pain relief from PRT

• Long-term benefits maintained for majority of patients

3. Ashar YK, Lumley MA, Perlis RH, et al. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain. JAMA Network Open. 2023;6(9):e2333846. doi:10.1001/jamanetworkopen.2023.33846

• Secondary analysis examining mechanism: reattributing pain to mind-brain processes

• Patients with largest drops in injury beliefs had largest drops in pain

• Published September 28, 2023

4. Tankha H, Lumley MA, Gordon A, Schubiner H, Uipi C, Harris J, Wager TD, Ashar YK. "I don't have chronic back pain anymore": Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain. The Journal of Pain. 2023;24(7):1163-1180. doi:10.1016/j.jpain.2023.02.019

• Qualitative study of patient experiences with PRT

• Key mechanisms: pain reappraisal, fear reduction, insight into pain-emotion connection

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Emotional Awareness and Expression Therapy (EAET) Studies

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5. Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial. JAMA Network Open. 2024;7(6):e2415842. doi:10.1001/jamanetworkopen.2024.15842

• Major VA study with 126 older veterans (ages 60-95)

• 63% of EAET participants achieved ≥30% pain reduction vs only 17% in CBT

• EAET superior for pain, anxiety, depression, PTSD symptoms, and life satisfaction

• Published June 2024

6. Yarns BC, Lumley MA, Cassidy JT, Steers WN, Osato S, Schubiner H, Sultzer DL. Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial. Pain Medicine. 2020;21(11):2811-2822. doi:10.1093/pm/pnaa145

• Preliminary VA trial showing EAET superiority over CBT

• 41.7% of EAET patients had >30% pain reduction vs one CBT patient

• Large effect sizes for pain reduction

7. Lumley MA, Schubiner H, Lockhart NA, Kidwell KM, Harte SE, Clauw DJ, Williams DA. Emotional Awareness and Expression Therapy, Cognitive Behavioral Therapy, and Education for Fibromyalgia: A Cluster-Randomized Controlled Trial. Pain. 2017;158(12):2354-2363. doi:10.1097/j.pain.0000000000001036

• Large trial with 230 fibromyalgia patients

• EAET superior to both education control and CBT for pain reduction

• 34.8% of EAET patients "much better" or "very much better" vs 15.4% in education

• EAET had advantages over CBT in achieving ≥50% pain reduction

8. Lumley MA, Schubiner H. Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review. Current Rheumatology Reports. 2019;21(7):30. doi:10.1007/s11926-019-0829-6

• Comprehensive review of EAET development and evidence base

• Reviews multiple trials across different pain conditions

• Published May 2019

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Psychophysiologic Symptom Relief Therapy (PSRT) Studies

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9. Donnino MW, Thompson GS, Mehta S, Paschali M, Howard P, Antonsen SB, Balaji L, Bertisch SM, Edwards R, Ngo LH, Grossestreuer AV. Psychophysiologic Symptom Relief Therapy for Chronic Back Pain: A Pilot Randomized Controlled Trial. Pain Reports. 2021;6(3):e959. doi:10.1097/PR9.0000000000000959

• Pilot study: 83% decrease in pain disability in PSRT group at 4 weeks

• 63.6% pain-free at 26 weeks in PSRT vs 25% MBSR and 16.7% usual care

• 12-week group program based on Sarno's work

• Published September 2021

10. Pester BD, Yamin JB, Cabrera MJ, Mehta S, Silverman J, Grossestreuer AV, Howard P, Edwards RR, Donnino MW. Change in Pain-Related Anxiety Mediates the Effects of Psychophysiologic Symptom Relief Therapy (PSRT) on Pain Disability for Chronic Back Pain. Journal of Pain Research. 2023;16:3871-3880. doi:10.2147/JPR.S416305

• Secondary analysis showing pain-related anxiety as key mediator

• Greater proportion achieving 30%, 50%, and 75% pain reduction in PSRT vs MBSR

• Published November 2023

11. Donnino M, Howard P, Mehta S, Silverman J, Cabrera MJ, Yamin JB, Balaji L, Berg KM, Heydrick S, Edwards R, Grossestreuer AV. Psychophysiologic Symptom Relief Therapy for Post-Acute Sequelae of Coronavirus Disease 2019. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2023;7(4):337-348. doi:10.1016/j.mayocpiqo.2023.05.002

• Application of PSRT to Long COVID (PASC) patients

• 23 patients with PASC for ≥12 weeks

• Significant improvements in symptom burden, fatigue, pain, anxiety

• Published May 2023

12. Edwards RR, Donnino MW. Psychophysiologic Symptom Relief Therapy for Chronic Back Pain: Hypothesis and Trial Rationale. Frontiers in Psychiatry. 2024;15:1-14. doi:10.3389/fpsyt.2024.1401047

• Theoretical framework and rationale for PSRT approach

• Paradigm shift in understanding non-specific chronic back pain

• Published 2024

Key Findings Across Studies:

• Pain Reprocessing Therapy (PRT): 66% pain-free rates with sustained 5-year benefits

• EAET: Superior to CBT for chronic pain, especially in patients with trauma/PTSD

• PSRT: Dramatic reductions in disability (83% at 4 weeks) with 64% pain-free at 6 months

All three approaches demonstrate that addressing the mind-body connection and neuroplastic mechanisms can produce substantial, lasting pain relief—superior to traditional treatments including medications, injections, and standard cognitive-behavioral therapy for appropriately selected patients.

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