233: Active Erasure of Emotional Images for Chronic Low Back Pain: A Case Series of Five Patients

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Non-pharmacological treatments

Background and Aims: Pain is a multifaceted experience shaped by sensory, cognitive, and emotional dimensions. While standard treatments include exercise and cognitive-behavioral therapy, we focus specifically on the emotional dimension. We previously developed a novel approach using emotion-arousing images, allowing individuals to actively "erase" perceived painful scenes through manual manipulation. Our prior work demonstrated improved pain intensity and thresholds in healthy individuals. To further expand upon these findings, the present study aimed to investigate the therapeutic effects and associated clinical changes of this intervention in five patients with specific and nonspecific chronic low back pain using a single-case study design.

Methods: Five patients with chronic low back pain (three nonspecific, one disc herniation, one spondylolysis; mean age 22±1.2 years) participated. An ABAB single-case design was used, with 8-day A-phases (non-intervention) and 6-day B-phases (intervention). In B-phases, participants used a tablet to actively erase "painful scenes" in emotion-arousing images by freely applying a blurring function. Outcome measures included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), and Visual Analog Scale for pain intensity and unpleasantness, assessed at each phase's start and end. Data were analyzed using visual inspection and the Tau-U method to calculate effect sizes.

Results: Tau-U analysis revealed individual-specific improvements. For PCS, two participants showed strong decreasing trends during A2–B2 (Tau-U=-1.25, p=0.052), indicating cognitive shifts. One participant showed consistent TSK improvement (Tau-U = -1.00 to -1.25), though others showed minimal changes. Pain intensity markedly decreased in three participants, including two with specific diagnoses, with large effect sizes (Tau-U = -1.00 to -1.25) in the later intervention phases. Unpleasantness decreased in four participants (Tau-U = -0.75 to -1.25) during specific phase comparisons. Notably, improvements in emotional components often preceded reductions in pain intensity, suggesting that the intervention effectively modulates the affective aspects of chronic pain.

Conclusions: This intervention may modulate cognitive and affective dimensions of chronic pain beyond sensory intensity. Heterogeneous responses—including cases where unpleasantness improved before pain intensity—suggest that voluntary control of visual pain-related information may directly or indirectly influence the brain's pain matrix and threat processing. Crucially, improvements in patients with structural pathologies (e.g., disc herniation) may indicate that this approach can modify central pain evaluation even in the presence of peripheral pathology. These findings highlight the potential of active image erasure as a novel non-pharmacological therapy. Future research should delineate responder characteristics to optimize clinical application for chronic low back pain.

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Presenting Author: Hiroshi Maeoka
Submitting Author: Hiroshi Maeoka

Senior Author: Hiroshi Maeoka

IASP 2026 Global Year theme of Neuropathic Pain: No

• Takahiko Fukumoto: Ph.D. - Kio University