Discussion
chronic back pain, Pain, pain
CHRONIC PAIN
We investigated how participants think about the underlying causes of their chronic back pain in their own words, and we tested how changes in pain attributions support pain reductions in pain reprocessing therapy (PRT). At baseline, few attributions pertained to mind or brain processes, even though many to most cases of chronic pain have a centralized component.Reattribution of pain from body to brain may be a valuable therapeutic target that is not a focus in leading psychological treatments (eg, cognitive behavioral therapy, acceptance and commitment therapy). These treatments typically present the causes of pain as complex or unknowable and describe the brain as providing “gate control,” a metaphor suggesting modulation of afferent nociceptive input. In contrast, PRT and related treatments (eg, Emotional Awareness and Expression Therapy, Explain Pain, and othersA theoretical focus on attributions is consistent with active inference and predictive processing models of brain function. In these models, the brain integrates prior beliefs and incoming sensory data to update generative models of the sources of sensations.An emphasis of reattribution in PRT is that mind- or brain-generated pain is nondangerous. This emphasis is supported by our finding that increased mind and brain attribution was associated with reduced harm beliefs and activity avoidance. (Although, surprisingly, greater mind-brain attributions were associated with greater pain intensity at pretreatment—see eAppendix in Attribution words related to emotions (eg, Natural language methods complement traditional self-reported rating scales.