Introduction
pain, primary pain, chronic back pain, psychiatric, primary chronic pain, tissue damage, bodily damage
OSTEOARTHRITIS, DISEASE, DISORDERS, PATHOPHYSIOLOGY, DYSFUNCTION, TENSION HEADACHE, CHRONIC PAIN
Beliefs that pain is due to peripheral pathophysiology (eg, a bulging disc, osteoarthritis) are common. Yet, peripheral findings are often incidental in nature and not the predominant cause of symptoms. For patients with primary or nociplastic chronic pain—including the majority of cases of chronic back pain, tension headache, and many other pain conditions—pain is driven predominantly by central upregulation and threat learning processes.We recently developed pain reprocessing therapy (PRT), a novel psychological treatment aiming to help patients reframe primary chronic pain as caused by nondangerous, reversible brain pathways. PRT presents primary pain as what could be described as a “false alarm” of tissue damage that can be reversed. PRT demonstrated promising efficacy in a 2022 clinical trialIn medically unexplained symptom disorders, the misattribution of symptoms to bodily damage or disease is recognized as a central factor driving dysfunction.We measured pain attributions before and after treatment using open-ended, free-text responses asking participants to describe the perceived causes of pain in their own words. Natural language approaches complement other valuable measurement tools. Relative to multiple choice–format questions, they provide a minimally constrained approach to studying how patients spontaneously think, capturing a broader set of concepts and beliefs than otherwise possible. Relative to qualitative analyses, they are quantitative and scalable (easily applied to large text data sets, eg, social media, electronic health record data). Natural language methods have been valuable in several psychiatric applications, including dimensional phenotyping