Episodic future thinking reduces chronic pain severity: A proof of concept study

Background: Chronic pain is a major public health challenge in the United States and around the world. Current treatments including opioid analgesics and cognitive behavioral therapy possess harmful side effects or limited efficacy, respectively. Chronic pain is associated with a variety of unhealthy behaviors including opioid misuse. Moreover, individuals who suffer from chronic pain exhibit excessive discounting of delayed rewards, suggesting a constricted temporal window of valuation. Reductions in the excessive discounting of delayed rewards has been achieved with Episodic Future Thinking (EFT; vividly imagining realistic future events). EFT has also been associated with reductions in a variety of unhealthy behaviors. In this study, the effects of EFT on delay discounting and levels of pain were investigated in individuals reporting chronic pain. Methods: Individuals reporting chronic pain (N = 250; 42.4 % female) were recruited through the Amazon Mechanical Turk platform. Measures of delay discounting and pain were collected at baseline and again after randomization to EFT (N = 128) or Control Episodic Thinking (CET) (N = 122). Results: EFT significantly reduced delay discounting relative to baseline (p < 0.001) and EFT reduced pain scores in a baseline dependent manner (p = 0.001) when compared to CET; that is, those with the greatest reports of pain experienced the greatest reduction. Furthermore the reduction in delay discounting fully mediated the reduction in pain. Conclusions: These findings suggest that Episodic Future Thinking, by widening the temporal window, may reduce pain in those reporting chronic pain and therefore represents a potential novel therapeutic.