Pain Reprocessing Therapy: A New Treatment Option for Chronic Pain

Many people experience chronic pain (long-term pain). Managing that pain can be a challenge, especially if your pain cannot be traced back to an injury or condition without a physical cause (like a torn muscle or worn-down joint).

Researchers developed a new form of pain management called pain reprocessing therapy. Although it’s still a new treatment, the techniques may in fact relieve chronic pain in people without physical evidence of injury or disease.

What is pain reprocessing therapy?

Pain reprocessing therapy (PRT) is a treatment approach that uses psychological techniques to help manage chronic pain. During training, PRT therapists guide you through motions that cause pain. The therapist then helps you to identify sensations and “unlearn” feeling pain. They can also help you identify and manage emotions that may make pain feel worse.

How does pain reprocessing therapy work?

Pain reprocessing therapy (PRT) attempts to retrain the brain to feel pain signals differently. Sometimes, you may feel pain even when there’s no sign of damage to your bones, joints, or other tissues.

Your brain and nerves are signaling pain (and you feel it — it’s real). But there’s no physical reason for your brain to send these signals (such as an injury or inflamed tissues). Instead, your brain may send out “false-alarm” pain messages.

These brain-related pain signals can trigger fear and avoidance, which may cause more pain. This may lead to more fear and avoidance. It’s a vicious cycle that reinforces the brain-generated pain signals that cause your chronic pain.

PRT aims to break this cycle by changing how you view and respond to pain. As the fear and avoidance fades, the pain often fades as well.

Retraining how the brain feels pain may sound like a far-fetched idea. But PRT therapists will help you do just that using five main tools:

• Education: You’ll learn how pain works and why some pain occurs because of a faulty signal in your brain.

• Understanding your pain: Your therapists will help rule out body-based causes of pain (like injury) and learn more about your specific pain triggers and fears.

• Somatic tracking: Therapists work with you to respond differently to sensations of pain using a series of techniques called “somatic tracking.” The goal is to help break the fear and avoidance cycle that strengthens brain-generated pain.

• Lowering overall stress: Your PRT therapist will also help you lower your overall stress and anxiety levels that can sometimes make your pain worse.

• Noticing positive sensations: As part of PRT, you’ll also get plenty of practice focusing on sensations in your body that feel safe or pleasant. This helps build up your resilience against pain.

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What can pain reprocessing therapy be used to treat?

Researchers have commonly tested PRT for back pain, which often has no physical cause. In a small study testing PRT for back pain, most people who tried the therapy experienced pain relief. Plus, almost two-thirds of people were nearly or entirely free of pain after PRT. Some were still pain-free after 1 year.

More studies are necessary to find out if PRT will really work for back pain and other forms of chronic pain. But in theory, any chronic pain not caused by injury or physical disease could be a good candidate for PRT.

Brain-generated pain may be a symptom of many different medical conditions, such as:

• Fibromyalgia

• Osteoarthritis

• Chronic back pain

What do you do during a pain reprocessing therapy session?

Once you and your healthcare team have found that the cause of your pain isn’t due to an injury, it may be time to consider PRT. The main set of techniques you’ll focus on during a therapy session is somatic tracking.

Somatic tracking is a set of PRT exercises designed to help reframe how you experience pain. Working with your therapist, you’ll practice three somatic tracking techniques during sessions:

• Mindfulness: With this technique, you practice describing your pain objectively. What does it feel like in the moment? Get curious. Where do you feel the pain? How would you describe the situation? Does it change or move when you focus on it? The goal is to shift your attention away from fear and judgment to more neutral ways to think about your pain.

• Safety reappraisal: Using the objective language you practiced through mindfulness, safety reappraisal starts to reframe your thoughts about pain. The goal is to shift from viewing pain as dangerous to viewing it as nonthreatening. For example, you might say, “I feel a deep burning sensation in my back when I bend over. But I know the muscles in my back are perfectly healthy. My brain is just misinterpreting the sensation as dangerous.”

• Positive affect induction: Retraining your brain to view pain as safe is a tall order. This technique stresses that it’s important to approach these exercises with a little humor and light-heartedness where possible. Its goal isn’t to minimize your pain. Rather, it’s to make the retraining process a little easier.

Besides practicing somatic tracking during your therapy sessions, your therapist will also ask you to practice at home. Along the way, you and your therapist will talk about other stressors or triggers that add to your pain and overall anxiety level.

You’ll also practice noticing positive sensations in your body. For example, you might use mindfulness to focus on the sensations of breathing. What does the cool air feel like when you breathe in? Do you notice the warmth of the air passing through your nose as you breathe out? This way, you also recognize your body has many sensations. It’s not just all pain.

PRT and somatic grounding exercises

In addition to PRT exercises, somatic grounding exercises can be used to reduce anxiety and enhance pain relief. Somatic grounding is a technique that focuses awareness on your immediate surroundings at a given moment. There are many forms of grounding exercises, but most involve being in touch with your senses. This includes:

• Identifying things you can see

• Holding or feeling an object in your hands 

• Smelling different scents in your environment

• Recognizing sounds around you

• Focusing on the way your mouth or lips taste at the moment

How long does it take for pain reprocessing therapy to work?

Because PRT is so new, it’s not clear yet how long it takes for it to work (or how long the results will last). But, in this study, people who tried PRT experienced pain relief after eight therapy sessions over 4 weeks.

That study focused on people with chronic back pain. And before they started, participants met with a physician to make sure the back pain wasn’t due to a physical injury or cause.

Where can you find a therapist offering pain reprocessing therapy?

Ask your healthcare team if you have any questions or concerns about your pain relief. They may agree that PRT could be a suitable method of pain management for you. Also, they may be able to help you find PRT therapists and other resources.

Look for a PRT provider who has completed a specialized certificate training in PRT. Several different types of healthcare professionals may offer pain reprocessing therapy including:

• Medical doctors

• Nurse practitioners

• Physician assistants

• Physical therapists

• Occupational therapists

• Osteopaths

• Physiotherapists

• Chiropractors

• Psychotherapists

• Psychologists

You can search the Pain Reprocessing Therapy Institute’s provider directory to find a certified practitioner near you. You can also search Google for a qualified practitioner. Keep in mind it may be difficult to find a pain reprocessing therapist near you because the treatment is relatively new.

Be careful to look for a licensed healthcare professional who is qualified to do PRT rather than a health or pain recovery coach.

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Written by:

Kristina Van Winkle, BSN, RN

Kristina Van Winkle, BSN, RN, is a registered nurse with over 15 years of experience caring for both pediatric and adult patients. She also owns a medical writing business, Write Shift RN, LLC.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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