Promising Results for New Psychological Treatments for Pain Relief
New pain recovery therapies offer patients some needed relief.
Posted May 28, 2026 | Reviewed by Gary Drevitch
One feature of modern multidisciplinary chronic pain treatment is its remarkable coordination between pain medicine and pain psychology professionals, who use contrasting but complementary techniques and goals when treating patients. Traditionally, pain psychology has relied on Cognitive Behavioral Therapy (CBT) that targets dysfunctional behaviors and cognitions thought to magnify the distress and disability associated with chronic pain. CBT has been demonstrated to be more effective than a placebo or wait list in many controlled trials. However, effect sizes achieved by CBT, especially for pain intensity, have been small. There is room for improvement in pain psychotherapy .
New pain recovery psychotherapies—including Pain Reprocessing Therapy (PRT) and Emotional Awareness and Expression Therapy (EAET)—propose a brain-centered theory of pain causation and aim for pain reduction or cessation. These therapies are based on emerging pain neuroscience models which view the perception of danger as more fundamental to pain experience than the extent of bodily damage. These target the nociplastic, or ICD -11, primary pain elements in chronic pain.
Multiple clinical trials of these therapies have demonstrated greater pain reduction than usual care or CBT. A randomized trial of PRT in patients with chronic back pain showed large reductions in pain, with 66% of patients randomized to PRT reporting that they were pain-free or nearly so at post-treatment, which was much greater than placebo or usual care, with effects maintained at 1-year and 5-year follow-ups. PRT was also superior in changing pain interference, depression , anger , mind-brain attributions, and fear of movement. Results of a subsequent randomized trial of PRT vs. CBT vs. usual care were presented at the 2026 meeting of the US Association for the Study of Pain. This trial addressed shortcomings of the previous trial, including no comparison to standard therapy; that the therapists were developers of PRT; and the use of a homogenous sample (mostly white, high education , low baseline pain). In this new trial, PRT was superior to both CBT and usual care at lowering pain intensity and pain interference and showed comparable effects to CBT on mood and sleep. In the PRT group, 24% were pain-free or nearly so, compared to 0% of CBT and 2% of usual care participants.
EAET shares the neuroscience model of PRT but targets emotional and interpersonal sequelae of adverse life experiences (e.g., chronic stress , abuse, trauma ) that appear to contribute to pain onset or chronicity. EAET was compared to CBT in a randomized trial for veterans over age 60 with chronic musculoskeletal pain. EAET reduced pain more than CBT at post-treatment and at 6-month follow-up, with greater number of participants reporting 50% pain reduction. A trial of EAET vs. CBT. vs. education in fibromyalgia found that EAET was superior to CBT at 6-month follow-up on the number of patients achieving 50% pain reduction.
Because these new psychotherapies address the causation of pain and seek pain relief or cessation, they infringe on clinical issues normally left to pain medicine by traditional CBT. With the arrival of pain-relieving psychotherapies, medical techniques of pain reduction no longer have universal priority over psychological techniques of pain reduction. Pain psychology practice may thus begin to separate from—or even rival—pain medicine practice. Independent pain psychology practice may become more common, as is seen with physical therapy and occupational therapy.
Some concerns remain: Pain medicine may be needed to identify and address nociceptive and neuropathic components, and to legitimize a “brain-centric” approach to chronic pain problems, more trials of these new therapies are needed with less select populations. Also, de-medicalizing chronic pain services may inadvertently remove some of the medical legitimacy of chronic pain.
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Mark Sullivan, M.D., Ph.D. , is Professor of Psychiatry and Behavioral Sciences as well as Adjunct Professor of Anesthesiology and Pain Medicine and Adjunct Professor of Bioethics and Humanities at the University of Washington.
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