The Boulder Back Pain Study, Explained: How 2 Out of 3 Became Pain-Free

Somewhere you read that "66% of people with chronic back pain became pain-free in four weeks," and your first reaction was the right one: that sounds made up. Numbers like that don't come from back pain. Back pain gets managed, not ended.

So this is the whole study, in plain words, including the parts that should make you pause. Read it as the skeptic you are. It holds up better than you'd expect, and it's more limited than the headline.

Who ran it

Scientists at the University of Colorado Boulder, led by Yoni Ashar and Tor Wager, working with the clinicians who developed the treatment. It was published in 2022 in a major medical journal, which is why it's the one trial everyone in this field points to.

The setup

They recruited 151 adults with back pain that had lasted at least six months. The average was about ten years. Most had already tried the usual things: PT, medications, injections. A doctor examined each person first to rule out anything that needed a different treatment.

Then they split them randomly into three groups:

• Pain reprocessing therapy. Also called the mind-body approach. One session with a doctor who explained that their pain was a reversible alarm, then eight one-hour sessions with a therapist over four weeks.
• Placebo injection. A saline shot into the back, with the participants told openly that it was a placebo. This was the fairest comparison, because it controls for attention and the hope that comes with any treatment.
• Usual care. Keep doing whatever you were already doing.

Everyone rated their pain before and after on a 0 to 10 scale, and again at one year. Some also had brain scans before and after.

What the treatment actually was

This is the part people skip, and it's the part that matters if you want to try it yourself.

The therapy had three moves. First, education: your pain is real and physical, and it's being produced by your brain as a protective alarm, not by damage in your spine. Participants gathered their own evidence for that: pain that moves, pain that tracks stress, scans that don't match how much it hurts, injuries that should have healed years ago.

Second, a practice the researchers call somatic tracking: paying attention to the pain with curiosity and calm instead of fear. Noticing the sensation and reminding yourself it's safe, the way you'd watch a toddler's tantrum once you know nothing is actually wrong.

Third, going back to normal life. Bending, lifting, sitting, all the things they'd been guarding against. The therapist also helped people notice the emotional pressure that often sits under the pain, and feel it instead of hurting.

No surgery. No injections. No new exercise program.

The results

After four weeks:

• Pain reprocessing therapy: 66% pain-free or nearly pain-free (a 0 or 1 out of 10). That's the "2 out of 3."
• Placebo injection: 20%.
• Usual care: 10%.

At one year, most of the treatment group's gains were still there. And the brain scans showed something physical: after treatment, areas of the brain involved in producing pain were less active, and the connections between pain regions and the brain's "safety" regions had changed. The change showed up in the hardware, which is the clearest answer to "so it was all in my head" that we know of. No, and also the treatment measurably changed what the brain was doing.

The honest limitations

This is one trial, and it has real limits.

• Pain levels were low to moderate. The average starting pain was about 4 out of 10. Nobody knows yet if the result holds for people whose pain is a 9.
• The participants were mostly white and college-educated. The sample doesn't look like the country.
• It was one site, and the therapists were trained by the people who invented the method. Trials run by the method's believers usually get better results than the same method run by strangers.
• It can't tell you which part did the work. Education, the practice, the return to activity, the emotional piece: the study tested the package, not the ingredients.
• Nobody knows if it works from a book or an app as well as from a therapist. The study used nine in-person sessions.

A small pilot at a Harvard teaching hospital found something similar, with 64% pain-free at six months versus 17% with usual care. It was 35 people, so call it a hint, not a confirmation. More trials are running. Until they report, "2 out of 3" is the best number available, and results vary.

Why it matters anyway

Back pain treatments don't produce numbers like this. Most trials of PT, injections and medications measure success as a few points on a scale, not pain gone. For a four-week treatment with no side effects to get 2 out of 3 people to pain-free or close to it, and for the result to hold a year later, is unusual enough that it's worth understanding why.

The why, in plain words: your brain's job is to protect you. After an injury, or during a hard stretch of life, it can learn to keep the alarm on. It usually borrows an excuse, a tweak lifting the car seat, a bad night's sleep, an old injury. The injury heals. The alarm doesn't. The treatment works by teaching the brain, with evidence, that it can stand down. Sounds crazy. It's also been tested.

What this means for you

If your MRI said "mild" or "normal for your age," if your pain has outlasted any injury by a year or more, if PT helped for a while and then wore off, if your back is worse in hard weeks or the week before your period, you look a lot like the people in this study. That doesn't guarantee anything, and a doctor should rule out anything serious first. But it means the question "could my pain be a learned alarm?" is a fair one to ask.

The approach the study used can be learned. The Good Back Days Program ($59, 30 days) teaches the same three moves, about 10 minutes a day, built for women who don't have nine therapy appointments to spare. You can also read the study itself; it's linked in the sources below.

FAQ

What is the Boulder back pain study?

A 2022 randomized trial by scientists at the University of Colorado Boulder. It tested pain reprocessing therapy in 151 adults with chronic back pain averaging about ten years. After four weeks, 66% of the treatment group were pain-free or nearly so, versus 20% with a placebo injection and 10% with usual care.

What is pain reprocessing therapy?

A short treatment that teaches people their pain is a reversible false alarm from the brain rather than a sign of damage. The pain is real and physical. People gather their own evidence for that, practice calm attention to sensations, and return to normal activity.

How long was the treatment?

Nine sessions in four weeks: one with a doctor, then eight one-hour sessions with a therapist.

Did the results last?

Most of the gains held at one year. Brain scans also showed reduced activity in pain-related regions after treatment. Results vary.

What are the study's main weaknesses?

Low to moderate starting pain, a mostly white and college-educated sample, one site with therapists trained by the developers, and no way to tell which part of the treatment mattered most. It's one trial.

Wondering whether your pain fits the pattern this study treated? Take the free 2-minute quiz and see how your back behaves, or try Day 1 of the practice free and see what the approach feels like.

This article is education, not medical advice, diagnosis or treatment. See a doctor about your back pain before acting on anything here, and get urgent care for warning signs: new bladder or bowel changes, numbness in the groin, a leg getting weaker, fever, unexplained weight loss, or a history of cancer or a serious fall.

Sources: 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. Donnino MW et al., PAIN Reports, 2021.