Ashar YK, Gordon A, Schubiner H, et al. - According to this randomized clinical trial, psychological treatment centered on changing patients’ views about the causes and threat value of pain may give substantial and long-lasting pain alleviation for persons suffering from chronic back pain.

• Thirty-three of 50 candidates (66%) randomized to 4 weeks of pain reprocessing therapy were pain-free or nearly pain-free at posttreatment vs 10 of 51 candidates (20%) randomized to placebo and 5 of 50 candidates (10%) randomized to usual care, with gains largely maintained through 1-year follow-up.

• Treatment effects on pain were mediated by lessened beliefs that pain indicates tissue damage, and longitudinal functional magnetic resonance imaging revealed decreased prefrontal responses to evoked back pain and increased resting prefrontal-somatosensory connectivity in patients randomized to treatment vs patients randomized to placebo or usual care.