Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial

Chronic back pain is the leading cause of disability worldwide, yet many cases lack a clear physical or organic cause. This pilot study tested whether psychophysiologic symptom relief therapy (PSRT)—a novel 12-week intervention based on the theory that nonspecific back pain is rooted in psychological and emotional factors—could reduce pain and disability better than standard care and mindfulness-based stress reduction (MBSR). The approach combines pain education grounded in psychophysiological theory, desensitization techniques, emotional expression training, and mindfulness meditation.

The study was a three-armed, randomized controlled trial involving 35 adults with nonspecific chronic back pain (11 in PSRT, 12 in MBSR, 12 in usual care). Participants completed validated questionnaires measuring disability (Roland-Morris Disability Questionnaire), pain bothersomeness, and pain-related anxiety at baseline and at 4, 8, 13, and 26 weeks. The PSRT group received 36 hours of instruction over 12 weeks, while MBSR participants received 22 hours over 8 weeks, and the usual care group continued with standard treatment.

Results demonstrated significant benefits for PSRT. At 26 weeks, the PSRT group showed a mean disability score reduction of 6.2 points (from 9.5 to 3.3) compared to 4.4 points for MBSR and 0.2 points for usual care. Notably, 63.6% of PSRT participants reported being pain-free (0/10 pain) at 26 weeks, compared to 25% in the MBSR group and 16.7% in usual care. The largest improvements occurred within the first 4 weeks, suggesting the psychophysiological education and desensitization components were particularly effective. Adherence was high (76% session attendance), and questionnaire completion was 100%.

These findings suggest PSRT is a feasible and potentially highly beneficial treatment for nonspecific chronic back pain, with rapid and substantial improvements in functional disability and pain relief. The approach offers a distinct paradigm shift from treating back pain as primarily physical—instead addressing underlying psychological stressors and conditioned pain responses. The authors conclude that larger randomized controlled trials are warranted to confirm these promising pilot results and establish PSRT as a viable treatment option for chronic back pain patients.