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Chronic PainPOWeRNCT07137715

Psychological Options for Wellness and Recovery (POWeR) Trial for Veterans With Chronic Back/Neck Pain

A study testing Pain reprocessing therapy (PRT) and Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) in people with Chronic Pain and Back Pain, run by University of Colorado, Denver at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn which treatment works better for veterans with chronic neck or back pain. This study is comparing three treatments: Pain Reprocessing Therapy (PRT), Cognitive Behavioral Therapy (CBT), and usual care (whatever a person is already doing to cope with their pain). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Pain reprocessing therapy (PRT) and Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
360 participants
Where
1 siteUnited States
Study dates
27 Mar 2026to Sep 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults (18 and older)
  • Be veterans
  • Have a history of chronic back or neck pain defined as pain at least half the days of the last 6 months.
  • Have moderate or greater pain, defined as pain intensity ≥4 in the past week

Who cannot join

  • Clinical presentation suggestive of back pain that is secondary or peripheral in nature, including self-reported leg pain that is worse than back pain (indicative of radiculopathy or sciatica), spine surgery within the past 6 months, fall, motor vehicle accident or other trauma related to back pain in the past 6 months, back pain due to an inflammatory disorder, infection, or malignant etiology as determined per medical provider review, known sensory abnormality in trunk or legs, recent large (>20 lbs) unexplained weight loss, difficulty controlling bowels (to screen out cauda equina syndrome), and self-reported diagnoses of specific inflammatory disorders (rheumatoid arthritis, polymyalgia rheumatica, scleroderma, Lupus, and polymyositis).
  • Additionally, patients who meet any of the following criteria are ineligible due to anticipated difficulties complying with study procedures:
  • Moderate or severe cognitive impairment
  • Unstable or severe untreated mental health condition, including active suicidal ideation
  • Unstable or end-stage medical disease including active cancer
  • Back surgery planned within the next 6 months
Show all 10Show fewer
  • Inability to communicate by telephone or video, including inability due to housing instability
  • Current pain-related litigation outside the VA (service connection-related applications are not excluded)
  • Having engaged in CBT or PRT for chronic pain in the past 6 months
  • Participants may be excluded based on the discretion of PIs Ashar and Frank

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Jonathan K Ashar, PhD contact

303.724.2536

yoni.ashar.@cuanschutz.edu

United States1 site, 1 recruiting
  • VA Eastern Colorado Health Care System

    Aurora, Colorado, 80045

    Charlotte Nolan, MPA

    Joseph W. Frank, MD, MPH

    Recruiting

Other trials in United States

About this study

Official title: Pain Reprocessing Therapy for Veterans With Chronic Back Pain: Comparative Efficacy and Facilitators and Barriers to Implementation

The goal of this clinical trial is to learn which treatment works better for veterans with chronic neck or back pain. This study is comparing three treatments: Pain Reprocessing Therapy (PRT), Cognitive Behavioral Therapy (CBT), and usual care (whatever a person is already doing to cope with their pain).

The main questions the study aims to answer are:

Read more
  1. Which treatment works better for lowering pain: PRT, CBT, or usual care?
  2. How do the effects of PRT compare with CBT and usual care in terms of pain relief and other factors such as emotional functioning, quality of life, anxiety, and pain medication use?

Participants will:

  1. Be randomly assigned to receive either PRT, CBT, or usual care.
  2. Complete questionnaires about their pain and health.
  3. If in the PRT or CBT group, have nine weekly therapy sessions over video calls with a therapist.
Read the detailed description

The current leading psychotherapeutic treatment for chronic pain is cognitive behavioral therapy (CBT-CP), which has been found to be safe and modestly efficacious in the treatment of chronic back or neck pain (CBNP). The fundamental goal of CBT-CP is to encourage participants to adopt an active, problem-solving approach to managing the challenges associated with chronic pain. CBT-CP intervention follows a standard structure of 9 sessions with the following objectives: 1) reducing the negative impact of pain on daily life 2) improving physical and emotional functioning 3) increasing effective coping skills for managing pain 4) reducing pain intensity. Recent evidence shows CBT provides a 1-1.5 point reduction in pain intensity on an 11-point pain scale when compared to treatment as usual.

Using advances in neuroscience and psychology, investigators recently developed a novel psychological treatment called Pain Reprocessing Therapy (PRT). Using a combination of cognitive, exposure-based, and somatic psychotherapy techniques, PRT aims to promote patients' reconceptualization of pain as due to reversible, non-dangerous brain activity rather than peripheral pathology. Critically, PRT aims to reduce or eliminate pain, rather than merely increase functioning.

In the first trial of PRT (N = 151), 66% of patients randomized to PRT were pain-free or nearly pain-free at post-treatment, compared to fewer than 20% of those in the placebo and usual care control groups. PRT has several critical conceptual distinctions from CBT including different approaches to pain subtyping, a different understanding of chronic pain etiology, differing treatment goals (recovery vs. improved functioning), and a different focus on non-pain psychosocial threats. Given the conceptual differences and early existing promising efficacy data of PRT, a critical next step to achieve practical improvements in Veteran health is a comparative effectiveness trial of PRT vs. CBT in a Veteran Affairs (VA) clinic, utilizing VA clinicians, VA treatment infrastructure, and Veteran participants.

Aim 1 of this study is to test the comparative effectiveness of PRT to CBT and usual care on pain severity (primary outcome) for veterans with CBNP at post-treatment (primary endpoint) and one year follow-up.

Aim 2 of this study is to test the comparative effectiveness of PRT to CBT and usual care on secondary patient-reported outcomes measuring core outcome domains, quality of life, and opioid medication use.

Aim 3 of this study is to identify key barriers and facilitators of PRT response in a Veteran population using qualitative methods in a subsample of participants (n = 40) and in clinicians learning PRT.

Being tested
Pain reprocessing therapy (PRT), Cognitive Behavioral Therapy for Chronic Pain (CBT-CP), Usual Care
Keywords
Pain Reprocessing Therapy (PRT), PRT, Chronic Pain, Veterans, Neck Pain, Back Pain, Cognitive Behavioral Therapy (CBT), CBT
Medical subject headings
Chronic Pain, Back Pain, Neck Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Pain reprocessing therapy (PRT)Behavioural

    A promising new psychotherapy for chronic pain

  • Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)Behavioural

    Also called Cognitive Behavioral Therapy (CBT)

    A psychotherapy for chronic pain that has 30+ years of research support.

  • Usual CareOther

    Also called Treatment as usual

    Participants will be asked to continue to do whatever they are currently doing to manage their pain.

Study groups in NCT07137715
Study groupRoleWhat they receive
Pain reprocessing therapy (PRT)ExperimentalPRT has 5 components: 1) education about the origin of pain in the brain, its reversibility, and the pain-fear cycle; 2) reinforcing education using personal biography; 3) "somatic tracking" of pain through mindfulness and reappraisal of pain sensations as non-dangerous; 4) lowering the level of personal threat that may trigger pain sensation; and 5) inducing positive affect in periods of pain. Patients will attend 1 assessment and education telehealth session with a physician followed by 8, 50-minute, therapist-led sessions. Pacing will be weekly for approximately 9 weeks. Treatment will be provided by experienced PRT clinicians. All PRT sessions will be remotely-delivered.
Receives: Behavioral: Pain reprocessing therapy (PRT)
Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)Active comparatorCBT-CP, considered the leading psychological treatment for chronic pain, is a structured, time-limited intervention that aims to teach patients how to better manage chronic pain and improve their quality of life. Participants will receive 9, 50-minute sessions of CBT-CP over 9 weeks. The VA CBT-CP protocol contains an initial orientation involving education and familiarization with the CBT-CP approach to chronic pain. The protocol then includes sessions that focus on topics such as exercise, relaxation, pleasant activities, cognitive coping, and sleep. All CBT-CP sessions will be remotely-delivered.
Receives: Behavioral: Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)
Usual CareActive comparatorParticipants will be asked to continue whatever they are already doing to care for their back pain. Length of the usual care condition will be 9 weeks, the expected completion time of the PRT and CBT arms.
Receives: Other: Usual Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pain intensity

    Last-week average pain intensity is assessed via the Brief Pain Inventory Short Form (BPI-SF). The BPI-SF assesses pain severity and its impact on functioning. It consists of 9 total items including 4 pain intensity items and 5 pain interference items. The 4 pain intensity items measure pain in the last week on a numerical rating scale of 0 (no pain at all) to 10 (pain as bad as you can imagine).

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

Secondary outcomes (8)
  1. Pain Interference

    Last-week average pain interference is assessed via the Brief Pain Inventory Short Form (BPI-SF). The BPI-SF assesses pain severity and its impact on functioning. It consists of 9 total items including 4 pain intensity items and 5 pain interference items. The 5 pain interference items measure the impact of pain on General Activity, Mood, Walking Ability, Normal Work, Relations with other people, Sleep, and Enjoyment of Life. Each area is rated on a numerical rating scale from 0 (does not interfere) to 10 (completely interferes).

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  2. Satisfaction with Life

    Satisfaction with Life is assessed via the self-reported 5-Item Satisfaction with Life Scale (SWLS). The SWLS measures an individual's global life satisfaction. Each item is rated on a 7-point Likert scale (1=Strongly Disagree and 7=Strongly Agree). The ratings are summed to determine an overall score.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  3. Depression

    Depression is assessed using the self-reported 4-item Patient-Reported Outcomes Measurement Information System Depression Short Form 4a (PROMIS-Depression-SF 4a). The individual items measure negative mood, loss of interest, helplessness, and hopelessness over the past 7 days. Each item is scored 1-5, and raw scores are then converted to a T-score using pre-determined cut-offs.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  4. Anxiety

    Anxiety is assessed using the self-reported 4-item Patient-Reported Outcomes Measurement Information System Anxiety Short Form 4a (PROMIS-Anxiety-SF 4a). The form's items measure an individual's fear, worry, tension, and difficulty concentrating over the past 7 days. Each item is scored 1-5, and raw scores are then converted to a T-score using pre-determined cut-offs.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  5. Fatigue

    Fatigue is assessed using the self-reported 4-item Patient-Reported Outcomes Measurement Information System Fatigue Short Form 4a (PROMIS-Fatigue-SF 4a). The form's items measure an individual's fatigue intensity, fatigue frequency, fatigue-related difficulty initiating actions, and feelings of energy depletion. Each item is scored 1-5, and raw scores are then converted to a T-score using pre-determined cut-offs.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  6. Post-Traumatic Stress Disorder (PTSD) Symptoms

    PTSD symptoms are assessed using the self-reported 6-item Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). All items are Yes/No questions. The first item screens whether the respondent has experienced a traumatic event, and the other five items assess how this trauma has affected them over the past month. The score is the number of Yes answers to the last five items. Respondents who answer No to the first item receive a score of 0 and do not answer the remaining items.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  7. Client satisfaction

    Client Satisfaction is assessed the Patients' Global Impression of Change (PGIC). The PGIC is a three-item self-report scale that measures a patient's belief about the efficacy of treatment for their physical health, emotional health, and pain severity. Each item is rated on a 7-point scale of 1 (Very much worse) to 7 (Very much improved).

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

  8. Medication Use

    Medication use is assessed in two ways: 1) electronic health record review and 2) patient self-report of past-week frequency of medication, drug, or supplement use to manage pain.

    Measured: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Aug 2025
  2. Study start27 Mar 2026
  3. Primary completionJan 2028 (estimated)
  4. Study completionSep 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Three-arm randomized controlled trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
360 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07137715
Sponsor's protocol ID
24-2398
Other IDs
HT9425-24-1-0915
Acronym
POWeR
Status last verified
Mar 2026
First submitted
11 Aug 2025
Last updated
31 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data sharing procedures have not been finalized. At a minimum, a complete, cleaned, de-identified copy of the final dataset used in conducting the final analyses of the study will be created and made available within one year after the completion of the study, pursuant to a Data Use Agreement (DUA) appropriately limiting use of the dataset and prohibiting the recipient from identifying or re-identifying (or taking steps to identify or re-identify) any individual whose data are included in the dataset. Depending on feasibility and guidance from VA Office of Research Oversight, a Limited Dataset (LDS) may be created and shared. We have not yet determined how to operationalize data sharing for this study. In the interim, contact the PI for questions or requests.

Questions about this trial

What is this clinical trial studying?

A study testing Pain reprocessing therapy (PRT) and Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) in people with Chronic Pain and Back Pain, run by University of Colorado, Denver at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 31 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Jonathan K Ashar, PhD (303.724.2536, yoni.ashar.@cuanschutz.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pain intensity (time frame: Post-treatment (at an average of 10 weeks) and 26, 39, and 52 weeks post-randomization). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Mar 2026; AzTrials last refreshed its copy on 8 Nov 2026.

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