CF 371: Pain Reprocessing Therapy & Chiropractic And Tramadol

Today we’re going to talk about Pain Reprocessing Therapy & Chiropractic And Tramadol

But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #371 Now if you missed last week’s episode, we talked about Unnecessary Surgery & Gabapentin Linked To Dementia.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. It’s back to school time which, as I mentioned last week, is traditionally our slower time of the year. What does slow time mean? It means sit around and tremble in fear that patients will never grace your door step again. It means You’re DONE in this town! Just kidding of course. What it means is you have time to clean off that pile of papers on the corner of your desk, get into that ‘Learning File’ on your computer. Take those courses you’ve been meaning to take. Get some marketing going for your practice. You know…..do the stuff you never have the time to do.  That’s what I’m doing anyway and it’s definitely what your Ol’ Uncle Jeffro suggests you get moving on too. Some of you are going to kick on the computer games. I see you!!! Don’t do it.  Invest your time.

Or waste your time. It’s totally up to you. But I suggest you invest it. You’re the hammer or your the nail, the bug or you’re the windshield. You either make things happen, watch things happen, or wonder what in the hell just happened.  You can probably guess which one I am in each scenario. Very few minutes go by in my day that are not invested in one way or another.

I’m almost 53 and I don’t have as much time to jack around as I used to have. I mean that figuratively as well as literally.  Speaking of being in a bit of a rush, I am this week so what do you say we cut the chit chat a-hole (that’s an old Nicolas Cage from The Rock reference there) and let’s get to the research. 

Item #1 The first one today is called, “Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain 5-Year Follow-Up of a Randomized Clinical Trial” by Ashar et al and published in JAMA Psychiatry on July 30, 2025 and aye carumba, es en fuego!

Remember, the citations can be found at chiropracticforward.com under this episode. 

Ashar YK, Low EL, Knight K, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. Published online July 30, 2025. doi:10.1001/jamapsychiatry.2025.1844

Why They Did It Effective treatments for chronic back pain (CBP) are lacking.1 We previously reported that a novel psychological treatment, pain reprocessing therapy (PRT), led to large reductions in CBP severity, with benefits generally maintained through 1-year follow-up.2 Here, we report clinical outcomes at the 5-year follow-up, testing the long-term durability of gains.

How They Did It This secondary analysis of a randomized clinical trial received institutional review board approval to invite participants to complete patient-reported outcome measures in 2023, 5 years after randomization. 

The trial protocol has been published previously.2 We followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. In 2017 to 2018, 151 adults with CBP recruited from community settings in the Boulder-Denver metropolitan area of Colorado reporting at least 4 of 10 pain intensity were randomized to 1 of 3 conditions: PRT, placebo, or usual care (UC) PRT participants attended 1 telehealth physician session and 8 face-to-face therapist sessions aiming to help participants reframe their CBP as due to nociplastic processes,3 reduce fear and avoidance of pain, and regulate nonpain threats (eg, anxiety, difficult emotions).4  Placebo participants received 1 open-label placebo injection subcutaneously into the back, accompanied by patient education about the power of placebo.5  

All participants, including UC participants, were asked to continue any ongoing CBP care.

What They Found Of 151 participants, 113  or 75% provided 5-year follow-up data, with similar follow-up rates by randomization group.  PRT participants reported significantly lower pain intensity at 5 years than placebo and UC participants.  In the PRT group, 21 participants (55%) were nearly or completely pain free at 5 years, compared with 10 placebo participants (26%) and 13 UC participants (36%)  The largest effects were found in harm beliefs (TSK-11) and in pain attributions to mind-brain processes

Wrap It Up This 5-year follow-up of a randomized clinical trial found that PRT provided long-term pain reduction in CBP.  Whereas improved coping with chronic pain is the goal of some psychological treatments, our findings indicate that PRT can provide durable recovery from CBP for some patients.  A main limitation is that the original trial sample had low to moderate severity of CBP2; studies testing PRT in higher-severity samples are needed.

Item #2 The second one today is called, “Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data” by Trager et al and published in British Medical Journal Open in 2024 and it’s at least still smoldering. 

Trager RJ, Cupler ZA, Srinivasan R, et al Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data BMJ Open 2024;14:e078105. doi: 10.1136/bmjopen-2023-078105

Why They Did It Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management.  However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored.  We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care.

How They Did It Retrospective cohort study. Setting was a US medical records-based dataset including over 115 million patients attending academic health centers, queried 9 November 2023. Participants were Opioid-naive adults aged 18–50 with a new diagnosis of radicular LBP. 

What They Found

Wrap It Up

This study found that US adults initially receiving chiropractic spinal manipulation for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger      

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