• Brandon C Yarns, Mark A Lumley, Justina T Cassidy, W Neil Steers, Sheryl Osato, Howard Schubiner, and David L Sultzer.
• Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California.
• Pain Med. 2020 Nov 1; 21 (11): 2811-2822.

ObjectiveEmotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain.DesignRandomized comparison trial.SettingOutpatient clinics at the West Los Angeles VA Medical Center.SubjectsFifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain.MethodsPatients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up.ResultsEAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance.ConclusionsThis trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.Published by Oxford University Press on behalf of the American Academy of Pain Medicine 2020. This work is written by US Government employees and is in the public domain in the US.

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