The Boulder Back Pain Study | Full Breakdown

Published March 4, 2026 · 10 min read

By Tauri Urbanik, Pain Science Researcher

The study that changed chronic pain treatment

In 2022, a team of researchers at the University of Colorado Boulder published results that stopped the chronic pain world in its tracks. Not because the findings were incremental. Because they were extraordinary.

Two-thirds of people with chronic back pain became pain-free. In four weeks. No surgery. No medication. No injections. Just a new way of understanding and relating to their pain.

The study was published in JAMA Psychiatry, one of the most respected medical journals in the world (Ashar et al., JAMA Psychiatry, 2022↗). It was funded by the NIH. And it used the gold standard of medical research: a randomized controlled trial.

Here's everything you need to know about it.

Study design: how they tested it

The researchers recruited 151 adults with chronic back pain. Not mild discomfort. These were people who'd been hurting for an average of several years. Real, persistent, life-disrupting pain.

Participants were randomly assigned to one of three groups:

Pain Reprocessing Therapy (PRT): 50 patients received 8 sessions over 4 weeks. The treatment taught them to reinterpret their pain as a brain-generated signal rather than evidence of body damage. Core techniques included somatic tracking, safety reappraisal, and education about neuroplastic pain.

Open-label placebo: 51 patients received a subcutaneous saline injection in their backs. They were told it was a placebo. This controlled for the general effects of receiving treatment and medical attention.

Usual care: 50 patients continued whatever they were already doing for their pain. No new intervention.

The design was rigorous. Randomized. Controlled. Blinded assessors. Published in a top-tier journal with full peer review.

The results

Let those numbers sink in. 66% of people in the PRT group were pain-free or nearly pain-free at the end of treatment. Compare that to 20% in the placebo group and 10% in the usual care group.

This wasn't a 10% improvement. It wasn't a modest effect. It was a fundamental shift. People who had been in pain for years walked out of 4 weeks of treatment without it.

What the brain scans revealed

Here's what makes this study special beyond the clinical outcomes. The researchers didn't just ask people how they felt. They looked inside their brains.

Every participant received fMRI brain scans before and after treatment. The PRT group showed measurable changes in brain regions involved in pain processing. Specifically, activity decreased in areas that evaluate the emotional significance of pain, like the anterior insula and anterior midcingulate cortex.

In plain language: their brains literally processed pain differently after treatment. The pain signal was still available, but the brain's response to it changed. It stopped treating the signal as dangerous.

This matters because it answers the skeptic's question. "Are people just saying they feel better?" No. The brain scans confirm something objective changed. The treatment altered brain function in measurable ways.

Why does PRT work so well?

The treatment is based on a specific model of chronic pain. Most chronic pain, the researchers argue, is neuroplastic. The brain learned to produce pain independently of tissue damage. The original cause may have been real, an injury, a strain, a disc issue. But the brain got stuck in a pain pattern even after the body healed.

PRT targets this directly. It teaches people three things:

First, that their pain is real but not dangerous. The brain is sending a false alarm. Understanding this reduces fear, and fear is the fuel that keeps neuroplastic pain burning.

Second, to observe pain sensations with curiosity instead of threat. This is somatic tracking. When you attend to pain without panic, you send your brain a safety signal. Over time, this recalibrates the pain response.

Third, to gather evidence of safety from daily life. Movements that don't hurt. Days that are better than expected. Pain that shifts or disappears during distraction. Each of these corrective experiences teaches the brain that the danger signal is wrong.

The 5-year follow-up

Clinical trials often show impressive short-term results that fade over time. So the durability question is critical. Do people stay pain-free?

The answer appears to be yes. Follow-up data shows the gains held at one year. And preliminary data at the 5-year mark suggests the results were durable for most participants. People who became pain-free generally stayed that way without ongoing treatment.

This makes sense when you understand the mechanism. PRT doesn't manage pain. It resolves the brain pattern generating it. Once your brain updates its assessment, once it stops interpreting normal body signals as dangerous, the pain signal turns off. And it stays off. Like learning that a shadow isn't a monster. Once you see it clearly, you can't unsee it.

Limitations worth knowing

No study is perfect, and being honest about limitations is important.

Sample size. 151 participants is solid for a clinical trial but not massive. Larger studies would strengthen the findings.

Back pain only. The study specifically tested chronic back pain. While the neuroplastic pain mechanism is shared across conditions, this trial didn't directly test migraines, fibromyalgia, IBS, or other pain conditions. Separate studies have shown brain-based approaches work for those conditions too, but this particular trial focused on backs.

Self-selected participants. People who volunteer for a study about brain-based pain treatment may already be open to the idea. The results might look different in people who are firmly convinced their pain is structural.

Therapist-delivered. PRT in the study was delivered by trained therapists. The book "The Way Out" adapted the approach for self-help, but the exact protocol in the trial involved professional guidance.

These are real limitations. But they don't diminish what the study showed. A brain-based treatment produced 66% pain-free rates in a rigorous trial. That's a landmark result by any measure.

What this means for chronic pain treatment

The Boulder study matters beyond its specific numbers. It validates a fundamentally different model of chronic pain. For decades, the dominant approach has been structural: find the damage, fix the damage. When that doesn't work, manage the symptoms.

This study says something different. It says most chronic back pain isn't structural. It's neuroplastic. And when you treat it as a brain problem, the results are dramatically better than treating it as a body problem.

M

Mark, 45

back pain for 9 years

Mark read about the Boulder study after his third round of physical therapy failed. Nine years of pain. Two MRIs showing "mild disc degeneration," the same finding present in most pain-free people his age. He'd always assumed his back was damaged. Learning that 66% of people like him became pain-free with brain retraining felt impossible. But also hopeful. He started PRT techniques and within 6 weeks, his constant pain became intermittent. Within 3 months, he had more pain-free days than painful ones. The study's numbers weren't just statistics anymore. They were his experience.

Composite story based on common patient patterns. Not a specific individual.

From research to your experience

The Boulder study is powerful evidence. But evidence only matters if it leads somewhere for you. The question isn't whether PRT works in a clinical trial. It's whether the neuroplastic pain model applies to your situation.

If your pain has lasted beyond normal healing time. If it moves around or fluctuates with stress. If imaging is normal or shows only age-related changes. If treatments targeting your body haven't worked. Those patterns suggest your brain may be generating the signal, just like the participants in this study.

Frequently asked questions

What is the Boulder back pain study?

The Boulder study is a 2022 randomized controlled trial published in JAMA Psychiatry. Led by Yoni Ashar at the University of Colorado Boulder, it tested Pain Reprocessing Therapy on 151 chronic back pain patients and found 66% became pain-free or nearly pain-free in 4 weeks.

How long did the Boulder study results last?

Follow-up data shows the results held at one year, and preliminary 5-year data suggests the gains were durable. Most participants who became pain-free stayed that way without ongoing treatment.

What did the brain scans show in the Boulder study?

fMRI scans showed that PRT reduced activity in pain-processing brain regions. Participants' brains literally changed how they processed pain signals, providing objective evidence that the treatment altered brain function, not just self-reported pain.

Does the Boulder study apply to conditions other than back pain?

The study specifically tested chronic back pain. However, the underlying mechanism, brain-generated pain through learned neural pathways, is shared across many chronic pain conditions. Separate studies show similar brain-based approaches work for fibromyalgia, migraines, and other conditions.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.DOI: 10.1001/jamapsychiatry.2021.2669
2. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.DOI: 10.3174/ajnr.A4173