For patients with chronic back pain, psychological treatment may provide substantial and durable pain relief, according to a study published in JAMA Psychiatry. Investigators who conducted a trial of longitudinal functional MRI (fMRI) randomly assigned patients to pain reprocessing therapy (PRT), with the goal of shifting patients’ beliefs about the causes and threat value of pain, placebo, or usual care. They observed large group differences in pain, with mean pain scores of 1.18 in the PRT group, 2.84 in the placebo group, and 3.13 in the usual care group. At post-treatment, 66% of patients randomly assigned to PRT were pain-free or nearly pain-free, compared with 20% assigned to placebo and 10% assigned to usual care. At 1-year follow-up, treatment effects were maintained, with a mean pain score of 1.51 in the PRT group, 2.79 in the placebo group, and 3.00 in the usual care group. In longitudinal fMRI, responses to evoked back pain in the anterior midcingulate and the anterior prefrontal cortex were reduced for PRT versus placebo and in the anterior insula for PRT versus usual care.