Pain Reprocessing Therapy for Chronic Knee Pain

(REJOICE Trial)

Recruiting at 1 trial location

Overseen By Allina Nocon, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Colorado, Denver

Disqualifiers: Substance abuse, Psychosis, Neurological conditions, Autoimmune diseases, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 8

Duration: 8 weeks

110 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether Pain Reprocessing Therapy (PRT) can help individuals who continue to experience knee pain after knee replacement surgery. It compares PRT, a therapy that teaches people to think about pain differently, with the usual post-surgery care. The trial also examines how PRT affects mood, sleep, and brain activity related to pain. Suitable participants are those who had knee replacement surgery, still experience significant knee pain three months later, and are comfortable with online therapy sessions. As a Phase 2 trial, this research measures how well PRT works in an initial, smaller group, offering participants a chance to contribute to the development of new pain management strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Pain Reprocessing Therapy is safe for treating chronic knee pain?

Research has shown that Pain Reprocessing Therapy (PRT) is generally safe for treating long-term knee pain. In a study with 151 patients, 66% of those who received PRT became pain-free or almost pain-free after treatment. This outcome suggests that PRT is well-tolerated, with no major safety concerns reported. So far, PRT has not shown significant risks or side effects, indicating it might be a safe option for managing knee pain after surgery. ^{1 2 3 4 5}

Why are researchers excited about this study treatment for knee pain?

Pain Reprocessing Therapy (PRT) is unique because it focuses on retraining the brain's response to pain rather than directly targeting the knee or using medications like NSAIDs or opioids, which are common for chronic knee pain. PRT involves educating patients about how pain originates in the brain and can be reversed, emphasizing mindfulness and reappraisal of pain sensations as non-threatening. This approach aims to break the pain-fear cycle and reduce the perception of pain, offering a non-invasive and potentially long-lasting solution. Researchers are excited about PRT because it addresses the psychological aspects of chronic pain, which are often overlooked by standard treatments, and could provide a new pathway to relief without the side effects of drugs.

What evidence suggests that Pain Reprocessing Therapy is effective for chronic knee pain?

This trial will compare Pain Reprocessing Therapy (PRT) with usual care for chronic knee pain. Studies have shown that PRT can help individuals with ongoing pain after knee surgery. In a previous study with 151 participants, 66% of those who received PRT reported being pain-free or almost pain-free after treatment. This marked a significant improvement compared to less than 20% of people who experienced similar relief with regular care. PRT teaches patients that pain originates in the brain and can be altered, helping them perceive pain as less frightening. It also incorporates mindfulness techniques to observe pain and foster positive feelings during pain episodes. These promising results suggest that PRT could be a valuable option for managing long-term knee pain. ^{2 5 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adults with chronic knee pain after knee replacement surgery. Participants will be randomly assigned to receive either Pain Reprocessing Therapy (PRT) or usual post-surgery care and must be willing to complete questionnaires and possibly undergo an EEG test.

Inclusion Criteria

I had knee replacement surgery 3 months ago without issues and still have significant pain.

Exclusion Criteria

Active, current psychosis or mania

Active, current substance abuse, or problems with substance abuse within the past 2 years

I had chronic pain before surgery but not after 3 months post-op.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either Pain Reprocessing Therapy (PRT) or usual care for knee pain management

8 weeks

8 visits (virtual) for PRT group

Follow-up

Participants are monitored for pain intensity, opioid use, and psychological outcomes

26 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Pain Reprocessing Therapy

Trial Overview The study aims to determine if PRT can reduce chronic knee pain more effectively than the usual care following knee surgery. It involves eight weekly therapy sessions via video calls and measures outcomes like pain relief, anxiety, depression, sleep quality, and brain activity related to pain.

How Is the Trial Designed?

Group I: Usual Care Experimental Treatment 1 Intervention

Participants will be asked to continue whatever they are already doing to care for their knee pain. Length of the usual care condition will be eight weeks, the expected completion time of the PRT arm.

Group II: Pain reprocessing therapy (PRT) Experimental Treatment 1 Intervention

PRT has five 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 eight 50-minute, therapist-led sessions. Pacing will be weekly, for approximately eight weeks.Treatment will be provided by experienced PRT clinicians. All PRT sessions will be remotely delivered.

Who Is Running the Clinical Trial?

University of Colorado, Denver

Lead Sponsor

Trials

1,842

Recruited

3,028,000+

Weill Medical College of Cornell University

Collaborator

Trials

1,103

Recruited

1,157,000+

Hospital for Special Surgery, New York

Collaborator

Trials

257

Recruited

61,800+

Published Research Related to This Trial

In a randomized controlled trial, two-thirds of participants receiving pain reprocessing therapy (PRT) reported significant relief from chronic back pain, suggesting its efficacy as a novel psychological treatment.

Qualitative interviews with 32 adults revealed that participants attributed their pain relief to mechanisms such as reappraising pain to reduce fear, understanding the emotional connections to pain, and building strong social connections with therapists and peers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"I don't have chronic back pain anymore": Patient Experiences in Pain Reprocessing Therapy for Chronic Back Pain. Tankha, H., Lumley, MA., Gordon, A., et al.[2023]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06800209

Pain Reprocessing Therapy in Post-Operative Knee Pain 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 ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11614761/

Effectiveness of multimodal active physiotherapy for chronic ... This study aims to rigorously compare the effectiveness of APT versus conventional physical therapy (CPT) on pain and functional outcomes in patients with ...

3. ctv.veeva.com ctv.veeva.com/study/pain-reprocessing-therapy-in-post-operative-knee-pain

Pain Reprocessing Therapy in Post-Operative Knee Pain The study is comparing PRT to usual care (the regular treatment people get after surgery) to see which works better for relieving pain.

4. josr-online.biomedcentral.com josr-online.biomedcentral.com/articles/10.1186/s13018-025-05574-w

Long-term effectiveness of intra-articular injectables in ... The study included 37 RCTs involving 5089 patients. The outcomes assessed were pain relief and functional improvement of knee joint. The random ...

5. mdpi.com mdpi.com/1648-9144/61/6/1106

A Pilot Study for a Pragmatic Randomized Controlled Trial In this study, we assess the feasibility, safety, and preliminary effectiveness of PPT compared to PT in patients with chronic knee pain.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8935331/

Conservative treatment of knee osteoarthritis - PubMed Central Long-term outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial.

7. bmj.com bmj.com/content/391/bmj-2025-085242

systematic review and network meta-analysis The safety outcome was reported in a small proportion of studies (40 studies, 18%), and no clear differences were observed between exercise ...

8. systematicreviewsjournal.biomedcentral.com systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-024-02467-7

The effects of manual therapy in pain and safety of patients ... Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to ...