Confronting trauma eases chronic pain in older veterans, research shows

A new study Led by UCLA Health and the U.S. Veterans Affairs Office, it has been found that chronic pain in older adults can be significantly reduced by a newly developed psychotherapy that works by confronting past trauma and stress-related emotions that can worsen pain symptoms.

Published in JAMA network opened On June 13, the study compared the newer therapy known as emotional awareness and expression therapy, or EAET, with traditional cognitive behavioral therapy, or CBT, in treating chronic pain and psychological symptoms such as depression, anxiety and post-traumatic complaints. symptoms of stress disorders in older veterans.

The study found that 63% of veterans who underwent EAET reported at least a 30% reduction in pain – a clinically significant reduction – after treatment, compared to only 17% of veterans who underwent cognitive behavioral therapy.

Pain reduction was maintained in 41% of EAET participants six months after treatment, compared to 14% of CBT patients. Additionally, EAET patients reported greater benefits in addressing anxiety, depression, PTSD and life satisfaction.

“Most people with chronic pain don’t consider psychotherapy at all. They think along the lines of medications, injections, sometimes surgery, or body treatments like physical therapy,” said lead author Brandon Yarns, an assistant professor in the Department of Health at UCLA. Psychiatry and Biobehavioral Sciences and Psychiatrist at Veteran’s Affairs Greater Los Angeles.

“Psychotherapy is an evidence-based treatment for chronic pain. What this study adds is that the type of psychotherapy matters.”

Cognitive behavioral therapy has long been the “gold standard” for the psychotherapeutic treatment of chronic pain among veterans, Yarns said. However, studies to date have shown that CBT provides modest benefits for relieving pain.

For chronic pain, patients undergo a treatment package that includes exercises similar to those used to treat depression or anxiety, such as guided imagery, muscle relaxation, cognitive restructuring, and activity stimulation. The end goal is for patients to improve their ability to tolerate their pain, Yarns said.

“The goal of CBT is not necessarily to cure pain, but to learn to cope and live well despite chronic pain,” Yarns said.

In comparison, EAET has one primary intervention: experiencing, expressing and releasing emotions.

Developed in the 2010s, the therapy aims to show patients that the brain’s perception of pain is strongly influenced by stress-related emotions. Patients are asked to focus on a stressful interaction, from something as mundane as being cut off by a driver to serious trauma such as sexual assault.

Yarns said the idea is to allow patients to experience these emotions both mentally and physically. The patients then try to face these emotions, express their reactions and ultimately let them go.

“When there is pain or stress, people have a range of normal, natural emotional responses. There may be anger, guilt and sadness. Because these feelings are painful, people often avoid them, but EAET helps people cope with difficult feelings with honesty and self-control -compassion,” Yarns said. “In therapy, they can let go of the anger, pain and guilt they carry and ultimately be left with self-compassion.”

For the study, researchers recruited 126 veterans – mostly men – aged 60 to 95 with at least three months of musculoskeletal pain. More than two-thirds of participants had a psychiatric diagnosis, while about a third had post-traumatic stress disorder. The study was the first large-scale clinical trial of EAET among older adults, older men and veterans, with previous studies largely consisting of younger, female participants, Yarns said.

Half of the participants underwent personal cognitive behavioral therapy, while the other half simultaneously underwent personal emotional awareness and expression therapy over nine sessions, including one personal session and eight small group sessions.

Patients were asked to rate their pain level using a scale of 0 to 10 on the Brief Pain Inventory before starting treatment, at the end of the nine sessions, and six months after the sessions ended. At post-treatment, 63% of EAET participants reported a pain reduction of at least 30%, compared to 17% of CBT patients.

Yarns said he is now investigating whether similar positive results can be replicated using virtual group sessions, comparing EAET and CBT and also including a mindfulness therapy cohort. Additionally, Yarns said neuroimaging studies will continue to understand the brain changes in participants in EAET versus CBT therapies.