New treatment may reduce chronic pain by ‘re-training the brain’
In a “major step forward in pain care”, a new approach to treat people living with chronic pain has been shown to reduce its intensity in a randomised controlled trial of 89 people.
The team behind the approach told journalists at a briefing this week that it has received funding from the Medical Research Future Fund to continue the next phase of the trial in a larger cohort of more than 300 participants in 2026.
Registrations are now open on the NeuroRecovery Research Hub website.
“Pain and Emotion Therapy” focuses on building skills in emotional regulation, mindfulness and distress tolerance to “retrain the emotional brain” and dampen overactivity that occurs due to chronic pain.
Janelle Blight, who lives with chronic low back, arthritic and neuropathic pain, says she was able to reduce her morphine dose for the first time in 30 years after being a participant in the clinical trial.
“I’ve been on a lot of opioids and things like that, but I’ve had nothing or found no course that’s been able to help take away the pain or help control the pain at home,” Blight said.
“By doing the course, I’ve been able to learn how to reduce my emotional side of my pain, which has helped my chronic pain in the end.”
Psychologist Dr Nahian Chowdhury said the findings of the trial, which have been published in the journal JAMA Network Open, “offers evidence that targeting emotion regulation is a viable intervention for chronic pain.”
Chowdhury is a research fellow at Neuroscience Research Australia and head of neurostimulation at the NeuroRecovery Research Hub of the University of New South Wales (UNSW). He’s on the same team as the authors of the paper but was not involved in the research.
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“Chronic pain is typically managed with a mix of physiotherapy, medications, and psychological support, and while those are helpful, this study shows emotion regulation training can offer more,” he says.
He describes the approach as “a major step forward” and says: “This research … empowers people to better manage the emotional challenges that control their pain experience.”
Chronic pain, defined as pain which persists for more than three months, affects 20-30 per cent of people.
“We’ve known now for some time that chronic pain is more than just ‘Ouch, it hurts’. It’s more than a sensory experience, it’s incredibly emotional,” says first author of the study Dr Nell Norman-Nott, a research fellow and clinical trial manager at the NeuroRecovery Research Hub.
Chronic pain is associated with heightened negative emotions – including anger, worry, and low mood. It is also associated with a reduced capacity to regulate emotions, which Norman-Nott describes as “difficulties being able to bring up positive emotions and dampen down negative emotions.”
“We see there’s this kind of cycle between worsening negative emotions, worsening pain, and increasing emotion dysregulation,” she said.
Emotional dysregulation contributes to symptoms of anxiety and depression, which are present in 50-80 per cent of people living with chronic pain. In 2021, the research team published a paper that found chronic pain is linked to measurable, pathological changes in the brain.
“We showed that chronic pain can result in a decrease in a brain chemical called GABA in the prefrontal cortex … the part of the brain that helps us manage and control our emotions,” says senior author Professor Sylvia Gustin, director of the Centre for Pain Impact at Neuroscience Research Australia.
Pain and Emotion Therapy learning resources. A. zoom sessions. B. Printed manual. C. App. Photo: Professor Sylvia Gustin and Dr Nell Norman-Nott, UNSW and NeuRA
“GABA is important because it helps calm down brain activity. So, when there isn’t enough of GABA, the brain can become overactive, and this over activity … can lead to increased emotional distress and worsening pain.”
Pain and Emotion Therapy involves 8 weekly group sessions over Zoom, in which a therapist teaches emotional skills adapted from dialectical behavioural therapy (DBT). These new skills are reinforced through self-directed learning with an additional handbook and app.
The first emotional skill is mindfulness, which Norman-Nott says is “about being present in that very moment without judgment, with awareness, and importantly, how to do this when you’re living every day with persistent pain.”
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“We teach skills in emotion regulation,” she adds.
“This is understanding emotions, naming emotions, how to change emotional responses, and how to bring up positive emotions so that it reduces vulnerability to intense feelings and stressful situations.
“We also teach distress tolerance skills which help to survive in emotional crisis. So, using strategies such as distraction, breathing exercises, head muscle relaxation and self-soothing.”
The trial recruited 89 Australian participants aged 26-77, 80 per cent of whom were female which Norman-Nott says is approximately representative of the chronic pain population. About half of participants received Pain and Emotion Therapy, and half continued with their usual treatment.
The participants were assessed using questionnaires at the start of the trial (baseline), at nine weeks, and after a six-month follow-up period.
After nine weeks, there were significant improvements in measures of emotion dysregulation, depression, anxiety, sleep problems and wellbeing in people who received Pain and Emotion Therapy compared to those who didn’t.
At six months, these participants continued to show lowered emotion dysregulation, and even reported significantly lower pain intensity, compared to those who received the usual treatment.
“The reduction in pain was a reduction of 1.3 on a 0-10 scale which is, when we look at the literature, a clinically meaningful difference in pain … so it would be noticeable to people,” says Norman-Nott.
According to Chowdhury, this is one of the first trials to show that teaching emotion regulation skills is helpful for individuals suffering from chronic pain and that it can be done effectively online and in group settings.
“This is a game changer for people with limited access to in-person care, such as those in rural and remote communities,” he says.
“The study’s methodological rigour is strong, with a pre-registered sample size of 90 determined via power analysis, aligning with gold-standard clinical trial protocols. Most importantly, the intervention outperformed treatment as usual — a critical benchmark.”
Professor Lorimer Moseley AO, a professor of clinical neurosciences and foundation chair in physiotherapy at the University of South Australia who was not involved in the research, says that the clinical trial raises the possibility – but does not prove – that treating emotional dysregulation can also improve pain levels.
“Old ideas of how pain works can’t explain that, but modern ideas can – our pain system is extraordinarily complex and the sensitivity of our pain system can be modified moment to moment and gradually over time through a wide range of strategies,” says Moseley.
“The best treatments we have for chronic pain are grounded in high quality education and active and psychological strategies that gradually reduce pain system hypersensitivity. We don’t know if this psychological intervention offers any benefit over any other intervention, but it raises the possibility that it might.”
The scaled-up trial will provide more robust evidence to assess this possibility in 2026.
