Pain Reprocessing Therapy for Chronic Primary Pain

Pain Reprocessing Therapy for Chronic Primary Pain Caused by a Likely Nociplastic Pain Mechanism in Primary Care: The PRIME-PRT Trial

Approximately 30% of adult Norwegians experience chronic pain, with its prevalence rising across demographics, including children and adolescents Chronic pain contributes to significant personal suffering and substantial societal costs. Traditional treatments - physical, pharmacological, and surgical - as well as psychological interventions, such as cognitive and acceptance-based therapies, demonstrate only minor to modest effects.

To address the challenge of rising demand alongside limited treatment options, university hospitals must consistently evaluate and adopt new, potentially effective therapies to meet their societal mission. Pain Reprocessing Therapy (PRT) is one such innovative treatment that has recently demonstrated promising results for a subset of chronic pain patients in a U.S. primary care setting.

In this study, the investigators want to assess the effectiveness of PRT on various outcomes in patients with primary chronic pain that has a likely nociplastic pain mechanism, within a Norwegian primary care population.

The insights from this study will be important for any prospective implementation of PRT to align with one of the guiding principles of the Norwegian healthcare system: the Best Effective Level of Care (BEON principle). The BEON principle supports the delivery of high-quality, cost-effective healthcare services and is founded on the notion of seamless integration across different levels of care. When competence or resources at the primary healthcare level are insufficient, more patients tend to be referred to higher, specialized, and inherently more costly levels of care, such as secondary and tertiary care. Therefore, if the study can demonstrate that PRT is effective within a Norwegian primary care population, the hypothesize is that its implementation could strengthen both primary and tertiary care in alignment with the BEON principle.

Inclusion Criteria:

• Age between 18 and 70
• On sick leave, or at risk of sick leave
• Pain intensity corresponding to 3 (or more) on the NRS from the PROMIS-29.
• Readiness to change, corresponding to the action stage from the readiness to change model, where they are ready to participate in their own change process

Exclusion Criteria:

• Structural causes for their pain (rheumatoid arthritis, cancer, etc.),
• Severe psychiatric conditions (ongoing or previous psychotic disorders, suicidality, or severe depression/anxiety/bipolar disorder)
• Illegal substance abuse, or known dependence on benzodiazepines or opioids
• Ongoing litigation or compensation process related to the pain condition
• Ongoing and severe psychosocial stressors (e.g. recent divorce etc.)