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A new clinical trial has shown that addressing the emotional experience of chronic pain may be a core component in effective pain management.
Chronic pain, defined as pain lasting three months or more, affects approximately 20–30% of people worldwide. In addition to physical suffering, people with chronic pain frequently experience psychological distress, including depression, anxiety, sleep problems, and reduced quality of life. Relatedly, suicide rates are estimated to be two to three times higher than those of the general population.
While a range of current treatments for chronic pain exist and some offer partial relief, many people continue to experience persistent physical and psychological symptoms. In a recent randomised clinical trial, published in JAMA Network Open, our group explored whether a new digital, psychological intervention, called Pain and Emotion Therapy could improve key outcomes for people living with chronic pain.
Understanding the role of emotion in chronic pain
Mounting research, including prior neuroimaging studies, have demonstrated that living with persistent pain may contribute to pathological changes in brain regions involved in emotional processing, namely the medial prefrontal cortex. It is perceived that these changes disrupt the brain’s ability to identify, express, and regulate emotions, a phenomenon referred to as emotion dysregulation. This emotion dysregulation has been considered to not only exacerbate psychological distress, potentially increasing vulnerability to psychological comorbidity such as anxiety and depression, but is also thought to intensify the sensory perception of pain itself.
A new therapy focused on retraining emotional processing
In response to these findings, we developed Pain and Emotion Therapy, an internet-delivered psychological intervention designed to decrease emotion dysregulation in people with chronic pain. The eight-week therapy course is delivered through eight therapist-guided video-based group sessions delivered over Zoom, and is supported by a self-guided smartphone app and printed workbook.
The therapy teaches participants to recognise and validate suppressed emotional responses, develop strategies to down-regulate emotional reactivity, and reconnect with positive emotions. It is based on dialectical behavioural therapy skills training, an evidenced-based approach for emotional dysregulation; extended to address key needs and psychoeducation relevant to people with chronic pain.
Results from the randomised controlled trial
Between March 2023 and September 2024, our group conducted a randomised controlled trial with 89 adults across Australia. Participants with chronic pain were randomly assigned to receive either Pain and Emotion Therapy or continue their usual care.
Findings showed significant improvement in participants’ abilities to regulate their emotions, which were sustained at six-month follow-up. Effects of Pain and Emotion Therapy extended to significant improvements in depression and anxiety symptoms, sleep problems, and wellbeing. Additionally, at six-month follow-up, those receiving Pain and Emotion Therapy showed a significant and clinically meaningful reduction in pain intensity representing a 10-point drop on a 100-point scale.
Filling a critical treatment gap
Although analgesics and traditional psychological therapies remain important in chronic pain management, both have limitations. Medications such as opioids may lose effectiveness over time and carry substantial risks, including dependency. Psychological interventions such as cognitive behavioural therapy are generally low-risk, but their benefits may be minimal long term, and they rarely address the emotional mechanisms that contribute to the persistence of chronic pain.
Pain and Emotion Therapy seeks to address this gap by targeting maladaptive emotion regulation as a key feature of persistent pain. The evidence from the current trial indicates that by retraining emotional responses, both psychological and sensory symptoms may be reduced. This represents a potentially powerful adjunct to current care models and may be particularly beneficial for individuals who have not responded to conventional treatments, or who identify difficulties in emotion regulation. The findings of the current trial contribute to a growing body of evidence showing that addressing the emotional experience of chronic pain may be a core component in effective pain management.
Expanding access through digital delivery
Accessibility remains a major challenge in pain care, particularly for people living in regional and rural areas or those with limited mobility. Delivering Pain and Emotion Therapy online helped us reduce some of these barriers. Participants were able to join group sessions from home and access app-based and workbook resources in their own time.
Our team engaged participants from every Australian state and territory, including individuals who may otherwise have been unable to attend in-person therapy due to limited mobility, geographical distance, or psychological distress.
Next steps
The promising outcomes from this randomised controlled trial support the need for broader implementation and evaluation. We are currently preparing for a larger clinical trial, funded by the Medical Research Future Fund, which will begin recruitment in early 2026. This trial will explore an individualised version of Pain and Emotion Therapy and will further investigate the effects to reduce pain severity. Individuals interested in participating in the trial may register their interest on the UNSW NeuroRecovery Research website.
Professor Sylvia Gustin is the director of the NeuroRecovery Research Hub, University of New South Wales and co-director of the Centre for Pain IMPACT, Neuroscience Research Australia.
Dr Nell Norman-Nott is research fellow and clinical trial manager at the University of New South Wales and Neuroscience Research Australia.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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