Preprint
Reconsolidation blockade with propranolol as a novel treatment for chronic low-back pain: a double-blind randomized placebo-controlled feasibility study
medRxiv, Vol.25 November 2025
Cold Spring Harbor Laboratory Press
2026
Appears in Thompson Institute Research Collection
Abstract
Purpose: Nociplastic pain is often characterized by maladaptive plasticity in the nervous system similar to that observed in patients with post-traumatic stress disorder (PTSD). The aim of this study was to investigate whether reconsolidation therapy, a treatment for PTSD consisting in reactivating (through trauma narrative) the synapses encoding the excessive threat response and blocking their reconsolidation using propranolol, is feasible in patients with nociplastic low-back pain.
Patients and methods: Design: triple-blind, placebo-controlled feasibility study.
Population: 24 adults with chronic (>6 months) nociplastic low-back pain with no comorbid PTSD or contra-indication to propranolol.
Intervention: Pain education (10 short videos) and 6 weekly sessions of reconsolidation therapy with propranolol (n=12) or placebo (n=12) administered orally 1h pre-reactivation).
Outcome measures:
Feasibility: recruitment rates, adverse events (frequency/severity).
Effect of intervention: Brain Pain Inventory (BPI) and other self-reported pain questionnaires, 4 weeks post-intervention.
Results: Sixty-six patients were screened over 6 months; 24 participants were enrolled; 2 dropped out. Adverse events were mild and infrequent (asymptomatic decrease in heart rate (n=4), headache and nausea (n=1). No clinically meaningful difference was observed between the two groups on the pain questionnaires. However, we noted prevalent catastrophic/kinesiophobic discourse during the sessions, and the reactivation methods appeared to have been suboptimal for the population.
Conclusion: Reconsolidation therapy is a feasible intervention for chronic pain. Preliminary results suggest no effect on pain symptoms. Additional studies are warranted to assess the adequacy of reactivation procedures (proper reactivation being required to trigger reconsolidation), and to investigate whether the absence of negative pain beliefs might be a prerequisite (unmet in this study) for the success of the intervention.
Competing Interest Statement
AB teaches reconsolidation therapy for the treatment of PTSD. There are no other conflicts of interest to declare.
Clinical Trial
NCT05085782
Details
- Title
- Reconsolidation blockade with propranolol as a novel treatment for chronic low-back pain: a double-blind randomized placebo-controlled feasibility study
- Authors
- Alexia Coulombe-Leveque - Université de SherbrookeSylvie Lafrenaye - Centre Hospitalier Universitaire de SherbrookeAlain Brunet - University of the Sunshine Coast, Queensland, Thompson InstituteSerge Marchand - Centre Hospitalier Universitaire de SherbrookeGuillaume Léonard (Corresponding Author) - Université de Sherbrooke
- Publication details
- medRxiv, Vol.25 November 2025
- Publisher
- Cold Spring Harbor Laboratory Press
- Date published
- 2026
- DOI
- 10.1101/2025.09.12.25335577
- Copyright note
- The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY 4.0 International license.
- Grant note
- The first author (ACL) is supported by a Fellowship from the Canadian Institutes of Health Research Fellowship; the study was funded by the Quebec Pain Research Network (Fonds de recherche du Quebec en Sante); and GL received salary support by the Fonds de recherche du Quebec en Sante (Senior Clinical Research Scholar).
- Organisation Unit
- Thompson Institute
- Language
- English
- Record Identifier
- 991200748902621
- Output Type
- Preprint
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