Key takeaways:
Pain reprocessing therapy is a new method of managing some types of chronic pain that are considered “brain-generated,” meaning the pain isn’t caused by an injury or physical condition.
The therapy aims to retrain the brain to interpret pain signals as non-threatening. It uses techniques such as mindfulness and reframing in the hopes of lowering your pain.
Pain reprocessing therapy is still very new. It’s only been tested for back pain so far. but it shows promise as a possible treatment for some types of 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 is still in the testing phase, the techniques may relieve chronic pain in people without physical evidence of injury or disease.
Pain reprocessing therapy (PRT) attempts to retrain the brain to feel pain signals differently. Sometimes, you may feel pain even when there is 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 is 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 does not occur because of an injury or illness. It starts as a faulty signal in your brain.
Understanding your pain: Your providers will help rule out body-based causes of pain (like injury) and learn more about your specific pain triggers and fears.
Somatic tracking: Providers work with you to respond differently to sensations of pain and activities that cause 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.
So far, researchers have only 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 pain-free 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:
Once you and your healthcare providers 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 designed to help reframe how you experience pain. Working with your therapist, you’ll practice three somatic tracking techniques during sessions:
Mindfulness: It’s time to 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 non-threatening. 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.
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 the only study on PRT so far, 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 was not due to a physical injury or cause.
Ask your healthcare provider if you have any questions or concerns about your pain relief. They may agree that PRT could be a suitable method of pain control for you. Also, they may be able to help you find PRT therapists and other resources.
Look for a provider who has completed a certificate training in PRT. Several different types of healthcare providers pay 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 so new.
Be careful to double-check any provider your contact is qualified to do PRT. You should also look for a licensed healthcare professional rather than a health or pain recovery coach.
The bottom line
Pain reprocessing therapy (PRT) is designed to help people with chronic pain that happens when pain signals get mistakenly generated by the brain. PRT therapists work with you to help you respond with less fear and avoidance to your pain.
People may then be able to lessen their pain when they realize its true source. They can also understand the nature of it and try new ways to mentally cope with it.
That said, researchers and healthcare professionals are still studying this technique. But, the results look promising for this new pain relief method.
Ashar, Y. K., et al. (2021). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain. JAMA Psychiatry.
Clauw, D. J. (2015). Diagnosing and treating chronic musculoskeletal pain based on underlying mechanisms. Best Practice & Research Clinical Rheumatology.
Gordon, A. (2021). How the brain causes chronic pain & how to stop it. Practical Pain Management.
Pain Reprocessing Therapy. (n.d.). Certification training overview.
Pain Reprocessing Therapy. (n.d.). Pain reprocessing therapy.
Pain Reprocessing Therapy. (2021). Treatment outline for pain reprocessing therapy.