{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:56:00Z","timestamp":1791982560736,"version":"4.4.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n In primary chronic back pain (CBP), the belief that pain indicates tissue damage is both inaccurate and unhelpful. Reattributing pain to mind or brain processes may support recovery.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To test whether the reattribution of pain to mind or brain processes was associated with pain relief in pain reprocessing therapy (PRT) and to validate natural language\u2013based tools for measuring patients\u2019 symptom attributions.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This secondary analysis of clinical trial data analyzed natural language data from patients with primary CBP randomized to PRT, placebo injection control, or usual care control groups and treated in a US university research setting. Eligible participants were adults aged 21 to 70 years with CBP recruited from the community. Enrollment extended from 2017 to 2018, with the current analyses conducted from 2020 to 2022.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n PRT included cognitive, behavioral, and somatic techniques to support reattributing pain to nondangerous, reversible mind or brain causes. Subcutaneous placebo injection and usual care were hypothesized not to affect pain attributions.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n At pretreatment and posttreatment, participants listed their top 3 perceived causes of pain in their own words (eg, football injury, bad posture, stress); pain intensity was measured as last-week average pain (0 to 10 rating, with 0 indicating no pain and 10 indicating greatest pain). The number of attributions categorized by masked coders as reflecting mind or brain processes were summed to yield mind-brain attribution scores (range, 0-3). An automated scoring algorithm was developed and benchmarked against human coder\u2013derived scores. A data-driven natural language processing (NLP) algorithm identified the dimensional structure of pain attributions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We enrolled 151 adults (81 female [54%], 134 White [89%], mean [SD] age, 41.1 [15.6] years) reporting moderate severity CBP (mean [SD] intensity, 4.10 [1.26]; mean [SD] duration, 10.0 [8.9] years). At pretreatment, 41 attributions (10%) were categorized as mind- or brain-related across intervention conditions. PRT led to significant increases in mind- or brain-related attributions, with 71 posttreatment attributions (51%) in the PRT condition categorized as mind- or brain-related, as compared with 22 (8%) in control conditions (mind-brain attribution scores: PRT vs placebo,\n g<\/jats:italic>\n \u2009=\u20091.95 [95% CI, 1.45-2.47]; PRT vs usual care,\n g<\/jats:italic>\n \u2009=\u20092.06 [95% CI, 1.57-2.60]). Consistent with hypothesized PRT mechanisms, increases in mind-brain attribution score were associated with reductions in pain intensity at posttreatment (standardized \u03b2\u2009=\u2009\u22120.25;\n t<\/jats:italic>\n 127<\/jats:sub>\n \u2009=\u2009\u22122.06;\n P<\/jats:italic>\n \u2009=\u2009.04) and mediated the effects of PRT vs control on 1-year follow-up pain intensity (\u03b2\u2009=\u2009\u22120.35 [95% CI, \u22120.07 to \u22120.63];\n P<\/jats:italic>\n \u2009=\u2009.05). The automated word-counting algorithm and human coder-derived scores achieved moderate and substantial agreement at pretreatment and posttreatment (Cohen \u03ba\u2009=\u20090.42 and 0.68, respectively). The data-driven NLP algorithm identified a principal dimension of mind and brain vs biomechanical attributions, converging with hypothesis-driven analyses.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this secondary analysis of a randomized trial, PRT increased attribution of primary CBP to mind- or brain-related causes. Increased mind-brain attribution was associated with reductions in pain intensity.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.33846","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T11:36:53Z","timestamp":1695901013000},"page":"e2333846","source":"Crossref","is-referenced-by-count":29,"title":["Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain"],"prefix":"10.1001","volume":"6","author":[{"given":"Yoni K.","family":"Ashar","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Lumley","sequence":"additional","affiliation":[{"name":"Department of Psychology, Wayne State University, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy H.","family":"Perlis","sequence":"additional","affiliation":[{"name":"Center for Quantitative Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Liston","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faith M.","family":"Gunning","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor D.","family":"Wager","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"issue":"1","key":"zoi230978r1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/j.pain.0000000000001389","article-title":"The IASP classification of chronic pain for ICD-11: chronic secondary musculoskeletal pain.","volume":"160","author":"Perrot","year":"2019","journal-title":"Pain"},{"issue":"10289","key":"zoi230978r2","doi-asserted-by":"publisher","first-page":"2098","DOI":"10.1016\/S0140-6736(21)00392-5","article-title":"Nociplastic pain: towards an understanding of prevalent pain conditions.","volume":"397","author":"Fitzcharles","year":"2021","journal-title":"Lancet"},{"issue":"7","key":"zoi230978r3","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1097\/j.pain.0000000000000507","article-title":"Do we need a third mechanistic descriptor for chronic pain states?","volume":"157","author":"Kosek","year":"2016","journal-title":"Pain"},{"key":"zoi230978r4","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1146\/clinpsy.2020.16.issue-1","article-title":"Behavioral conceptualization and treatment of chronic pain.","volume":"16","author":"Vlaeyen","year":"2020","journal-title":"Annu Rev Clin Psychol"},{"key":"zoi230978r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2020.103635","article-title":"Fear in the context of pain: lessons learned from 100 years of fear conditioning research.","volume":"131","author":"Meulders","year":"2020","journal-title":"Behav Res Ther"},{"issue":"1","key":"zoi230978r6","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1001\/jamapsychiatry.2021.2669","article-title":"Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial.","volume":"79","author":"Ashar","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"Pt A","key":"zoi230978r7","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.neubiorev.2017.01.015","article-title":"Symptoms and the body: taking the inferential leap.","volume":"74","author":"Van den Bergh","year":"2017","journal-title":"Neurosci Biobehav Rev"},{"issue":"7","key":"zoi230978r8","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.cpr.2007.07.005","article-title":"Explaining medically unexplained symptoms\u2014models and mechanisms.","volume":"27","author":"Rief","year":"2007","journal-title":"Clin Psychol Rev"},{"issue":"5","key":"zoi230978r9","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1037\/0033-2909.130.5.793","article-title":"Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model.","volume":"130","author":"Brown","year":"2004","journal-title":"Psychol Bull"},{"key":"zoi230978r10","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1192\/bjp.157.3.404","article-title":"Hypochondriasis and somatosensory amplification.","volume":"157","author":"Barsky","year":"1990","journal-title":"Br J Psychiatry"},{"issue":"3","key":"zoi230978r11","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/j.jpsychores.2013.05.005","article-title":"Descriptive and predictive validity of somatic attributions in patients with somatoform disorders: a systematic review of quantitative research.","volume":"75","author":"Douzenis","year":"2013","journal-title":"J Psychosom Res"},{"issue":"1","key":"zoi230978r12","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jpsychores.2009.06.011","article-title":"Causal symptom attributions in somatoform disorder and chronic pain.","volume":"68","author":"Hiller","year":"2010","journal-title":"J Psychosom Res"},{"issue":"7","key":"zoi230978r13","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.1007\/s00586-021-06809-0","article-title":"The catastrophization effects of an MRI report on the patient and surgeon and the benefits of \u2018clinical reporting\u2019: results from an RCT and blinded trials.","volume":"30","author":"Rajasekaran","year":"2021","journal-title":"Eur Spine J"},{"issue":"2","key":"zoi230978r14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37371","article-title":"Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care.","volume":"4","author":"Stevans","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"12","key":"zoi230978r15","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1016\/j.biopsych.2018.01.011","article-title":"High throughput phenotyping for dimensional psychopathology in electronic health records.","volume":"83","author":"McCoy","year":"2018","journal-title":"Biol Psychiatry"},{"issue":"6","key":"zoi230978r16","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.1097\/j.pain.0000000000002175","article-title":"Quantitative language features identify placebo responders in chronic back pain.","volume":"162","author":"Berger","year":"2021","journal-title":"Pain"},{"issue":"2","key":"zoi230978r18","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1097\/PSY.0000000000000654","article-title":"Psychological therapy for centralized pain: an integrative assessment and treatment model.","volume":"81","author":"Lumley","year":"2019","journal-title":"Psychosom Med"},{"issue":"12","key":"zoi230978r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0015591","article-title":"Placebos without deception: a randomized controlled trial in irritable bowel syndrome.","volume":"5","author":"Kaptchuk","year":"2010","journal-title":"PLoS One"},{"issue":"3","key":"zoi230978r20","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1080\/08870449608400270","article-title":"The illness perception questionnaire: a new method for assessing the cognitive representation of illness.","volume":"11","author":"Weinman","year":"1996","journal-title":"Psychol Health"},{"issue":"1-2","key":"zoi230978r22","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.pain.2005.05.029","article-title":"Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia.","volume":"117","author":"Woby","year":"2005","journal-title":"Pain"},{"issue":"10","key":"zoi230978r23","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.jpain.2012.07.001","article-title":"Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11).","volume":"13","author":"Tkachuk","year":"2012","journal-title":"J Pain"},{"issue":"2","key":"zoi230978r24","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/00002508-200403000-00007","article-title":"Confirmatory factor analysis of the Tampa Scale for Kinesiophobia: invariant two-factor model across low back pain patients and fibromyalgia patients.","volume":"20","author":"Goubert","year":"2004","journal-title":"Clin J Pain"},{"issue":"4","key":"zoi230978r25","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1037\/1040-3590.7.4.524","article-title":"The Pain Catastrophizing Scale: development and validation.","volume":"7","author":"Sullivan","year":"1995","journal-title":"Psychol Assess"},{"issue":"3","key":"zoi230978r26","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/S0304-3959(03)00076-9","article-title":"One- and two-item measures of pain beliefs and coping strategies.","volume":"104","author":"Jensen","year":"2003","journal-title":"Pain"},{"key":"zoi230978r27","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3044864","article-title":"Text scaling for open-ended survey responses and social media posts.","author":"Hobbs","year":"2017","journal-title":"SSRN"},{"issue":"9","key":"zoi230978r29","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.jpain.2015.05.005","article-title":"Fifteen years of explaining pain: the past, present, and future.","volume":"16","author":"Moseley","year":"2015","journal-title":"J Pain"},{"issue":"5","key":"zoi230978r30","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1001\/jama.2022.9930","article-title":"Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain.","volume":"328","author":"Bagg","year":"2022","journal-title":"JAMA"},{"issue":"6","key":"zoi230978r31","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1002\/ejp.2013.17.issue-6","article-title":"Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial.","volume":"17","author":"Vibe Fersum","year":"2013","journal-title":"Eur J Pain"},{"issue":"12","key":"zoi230978r32","doi-asserted-by":"publisher","first-page":"2354","DOI":"10.1097\/j.pain.0000000000001036","article-title":"Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial.","volume":"158","author":"Lumley","year":"2017","journal-title":"Pain"},{"issue":"1","key":"zoi230978r33","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.tins.2020.09.012","article-title":"Computational models of interoception and body regulation.","volume":"44","author":"Petzschner","year":"2021","journal-title":"Trends Neurosci"},{"key":"zoi230978r34","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsycho.2021.108242","article-title":"Interoception as modeling, allostasis as control.","volume":"167","author":"Sennesh","year":"2022","journal-title":"Biol Psychol"},{"issue":"7","key":"zoi230978r35","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1038\/nrn3950","article-title":"Interoceptive predictions in the brain.","volume":"16","author":"Barrett","year":"2015","journal-title":"Nat Rev Neurosci"},{"issue":"6","key":"zoi230978r36","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.bpsc.2017.12.004","article-title":"Interoception and mental health: a roadmap.","volume":"3","author":"Khalsa","year":"2018","journal-title":"Biol Psychiatry Cogn Neurosci Neuroimaging"},{"issue":"1","key":"zoi230978r37","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/scan\/nsx060","article-title":"The theory of constructed emotion: an active inference account of interoception and categorization.","volume":"12","author":"Barrett","year":"2017","journal-title":"Soc Cogn Affect Neurosci"},{"issue":"2","key":"zoi230978r38","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.celrep.2019.09.011","article-title":"Dual and opposing functions of the central amygdala in the modulation of pain.","volume":"29","author":"Wilson","year":"2019","journal-title":"Cell Rep"},{"key":"zoi230978r39","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.68760","article-title":"An inhibitory circuit from central amygdala to zona incerta drives pain-related behaviors in mice.","author":"Singh","year":"2022","journal-title":"Elife"},{"issue":"5","key":"zoi230978r40","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/j.celrep.2018.03.139","article-title":"Scaling up cortical control inhibits pain.","volume":"23","author":"Dale","year":"2018","journal-title":"Cell Rep"},{"issue":"6359","key":"zoi230978r41","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1126\/science.aan1221","article-title":"Interactions between brain and spinal cord mediate value effects in nocebo hyperalgesia.","volume":"358","author":"Tinnermann","year":"2017","journal-title":"Science"},{"key":"zoi230978r42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2023.04.006","article-title":"\u201cI don\u2019t have chronic back pain anymore\u201d: patient experiences in pain reprocessing therapy for chronic back pain.","author":"Tankha","year":"2023","journal-title":"J Pain"},{"issue":"2","key":"zoi230978r43","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/pme.2014.15.issue-2","article-title":"Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: a systematic review.","volume":"15","author":"Tesarz","year":"2014","journal-title":"Pain Med"},{"issue":"6","key":"zoi230978r44","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1037\/amp0000678","article-title":"Emotion regulation as a transdiagnostic factor underlying co-occurring chronic pain and problematic opioid use.","volume":"75","author":"Aaron","year":"2020","journal-title":"Am Psychol"},{"issue":"1","key":"zoi230978r45","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/1471-2474-15-50","article-title":"A systematic review and meta-synthesis of the impact of low back pain on people\u2019s lives.","volume":"15","author":"Froud","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"issue":"11","key":"zoi230978r46","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1016\/j.jpain.2021.04.005","article-title":"The effect of literacy-adapted psychosocial treatments on biomedical and biopsychosocial pain conceptualization.","volume":"22","author":"Morais","year":"2021","journal-title":"J Pain"},{"key":"zoi230978r17","unstructured":"Ashar? YK, Lumley? MA, Perlis? RH, . Ashar_2023_CBP_reattribution. GitHub. Accessed April 20, 2023. https:\/\/github.com\/yonestar\/Ashar_2023_CBP_reattribution"},{"key":"zoi230978r21","doi-asserted-by":"crossref","unstructured":"Cleeland? C. Brief pain inventory (short form). Pain Research Group. Published online 1991. Accessed April 20, 2023. http:\/\/www.npcrc.org\/files\/news\/briefpain_short.pdf","DOI":"10.1037\/t04175-000"},{"key":"zoi230978r28","unstructured":"Hobbs? W. Parrot toolbox. Github repository. Last updated January 2020. Accessed April 20, 2023. https:\/\/github.com\/wilryh\/parrot"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2809959\/ashar_2023_oi_230978_1695236365.91676.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T11:37:00Z","timestamp":1695901020000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2809959"}},"subtitle":["A Secondary Analysis of a Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2023,9,28]]},"references-count":46,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,5]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.33846","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,28]]}}}