When Jabez Allies developed chronic lower back pain 10 years ago, her doctor sent her to the physio, who recommended different types of stretching and exercises – some that helped, some that didn’t help at all – as well as hot-water bottles and painkillers.
But as the pain got progressively worse every year, so too did Allies’ feelings of being overwhelmed – frustrated she couldn’t do the things she could before and spiralling into hopelessness that there was nothing she could do to fix it.
The effectiveness of the physio’s exercises depended on regularity, but often feelings of being depressed about her pain got in the way of being disciplined in doing them – and actually compounded her pain.
Yet health professionals only ever discussed treatments for the sensory physical experience, never the emotions that accompanied them.
Bu according to a new study led by the University of New South Wales and Neuroscience Research Australia, helping people with chronic pain manage their emotions can lessen their experience of pain.
The researchers assessed the efficacy of a new online course that has adapted dialectical behaviour therapy specifically for chronic pain over eight therapist-guided sessions delivered in an online group setting.
The trial, which began recruitment in March 2023 and was completed by September 2024, involved 89 people with chronic pain, half of whom participated in the online therapy over nine weeks, which was reinforced by an accompanying app and a handbook for self-learning, in addition to their usual treatment. The other half of the participants only received their usual treatment.
Of the participants, 83% were female, which is approximately representative of the chronic pain population, the authors said.
The results, published on Wednesday in the American Medical Association’s JAMA Network Open journal, showed those who received the new treatment reported better emotional regulation as well as pain reduction equal to a 10-point decrease on a 100-point scale for pain intensity within a six-month follow-up.
Prof Sylvia Gustin, one of the co-lead authors who developed the course, said those living with chronic pain are often stigmatised and told that it is all in their head – “but this is simply not true”.
“There is a real measurable change happening in the brain. In 2021 we showed that chronic pain can result in a decrease in a brain chemical called GABA in the prefrontal cortex … the part of the brain that helps us manage and control our emotions,” Gustin said.
GABA helps calm down brain activity, Gustin said, “so when there isn’t enough, the brain can become overactive and this overactivity of the brain in the prefrontal cortex can lead to increased emotional distress and worsening pain”.
Co-lead author Dr Nell Norman-Nott said she and Gustin developed the online course to meet the specific needs of people living with chronic pain, “retraining the brain to dampen down the overactivity that we know occurs due to chronic pain”.
Norman-Nott said the three key areas of the course are mindfulness (being present in the moment with awareness), emotional regulation (understanding emotions and how to change emotional responses) and distress tolerance skills to help survive an emotional crisis using strategies such as distraction, breathing exercises, muscle relaxation and self-soothing.
Norman-Nott said while prescription and non-prescription pain medications continue to play an important role, the treatment of chronic pain has shifted to a more holistic model that also addresses social and psychological experiences.
Gustin said the study was inclusive of all types of chronic pain – from neuropathic to musculoskeletal pain, migraine and fibromyalgia – because “it doesn’t matter which type of pain you have, the emotions suffered are very similar”.
Having completed the course more than a year ago, Allies said the range of techniques continue to help her feel like she has more control, rather than being a “victim of the pain”.
“It’s not just [that] my experience of the pain is less, but I’m also able to do more,” she said.
“Now I’m going out and I’m playing pickleball, I’m doing more strengthening exercises, and I’m going to the gym because I don’t have to spiral down out of control and be depressed about my pain.”
The researchers’ next step will be to conduct a bigger trial in 2026 with more than 300 participants.
Prof Lorimer Moseley, a pain scientist at the University of South Australia, said chronic pain is “one of the most challenging and burdensome health problems we face”.
“This clinical trial shows that psychological treatment can help, just as it can help people without chronic pain. That’s not very surprising. It also raises the possibility – but does not prove it – that treating emotional dysregulation can also improve pain levels,” he said.
“Old ideas of how pain works can’t explain that, but modern ideas can. Our pain system is extraordinarily complex and the sensitivity of our pain system can be modified moment to moment and gradually over time through a wide range of strategies.”
