What is Pain Reprocessing Therapy (PRT)?

If you put your hand on a hot stove, you want pain.

That probably sounds like a strange way to begin an article about chronic pain treatment, but pain has an important job. It’s your brain’s alarm system. It gets your hand off the stove before you cause more damage. It tells you to stop walking on a freshly broken ankle. Pain is meant to protect you.

But what happens when the alarm keeps going off when there is no longer a fire?

That is where Pain Reprocessing Therapy, or PRT, comes in.

What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy is an approach designed to help the brain relearn that signals from the body it has interpreted as dangerous are actually safe, breaking the cycle of chronic neuroplastic pain.

Neuroplastic pain occurs when the brain interprets safe or neutral signals from the body as dangerous and produces pain in response. The pain is completely real. The problem is not that someone is imagining their symptoms or “making them up.” The problem is that the brain’s very real alarm system has become overprotective.

Think of a smoke detector that goes off every time you make toast. There is nothing wrong with having a smoke detector. You definitely want one when your house is on fire. But you probably don’t want to evacuate the house every morning because your bagel got a little crispy.

With neuroplastic symptoms, the brain has essentially become too good at protecting you.

PRT works to help it relearn what is actually dangerous and what is safe.

How can the brain cause real physical pain?

One of the hardest things for many people to wrap their minds around is that pain can come from the brain even when there is not ongoing damage in the part of the body that hurts.

We tend to assume: My back hurts → there must be something wrong with my back.

Sometimes, of course, there is. Acute pain following an injury serves an important purpose.

But pain is ultimately a protective output of the brain, not a damage meter. Your brain is constantly taking in information and deciding how much danger it believes you are in.

And brains can make mistakes.

Imagine I toss a football toward you. You might automatically put your hands out to catch it.

Now imagine I toss the exact same object toward you, but you genuinely believe it is a grenade.

The object didn’t change. Your interpretation of it did. Your body would respond very differently because your brain believes you are in danger.

Something similar can happen with chronic symptoms.

A movement, position, activity, physical sensation, stressful situation, or even a particular time of day can become associated with danger. The brain learns the association and begins responding protectively.

And unfortunately, the more often something is learned, the more automatic it can become.

The pain-fear cycle

Let’s say your back starts hurting while you are sitting at your desk. You immediately think, Here we go again.

You shift positions. You check the pain. You wonder if you have been sitting too long. Maybe you shouldn’t sit like this. You remember what the MRI showed. You Google something. You get frustrated because yesterday was a good day and you thought you were finally getting better.

Every one of those reactions makes sense.

But from your brain’s perspective, you are also paying a lot of attention to a possible threat.

The pain becomes frightening. The fear tells the brain there is danger. The brain becomes more vigilant and produces or amplifies symptoms. The increase in symptoms then seems to confirm that something really is wrong.

More pain creates more fear. More fear creates more pain. Around and around we go.

PRT works on interrupting that cycle.

And importantly, this does not mean learning to ignore pain. It means learning to respond to a safe sensation as if it is safe…because it is.

What does PRT actually look like?

This is where I think PRT can sound much more complicated on paper than it often looks in real life.

A session isn’t usually fifty minutes of someone telling you, “Your pain isn’t dangerous,” until you believe them.

The work is much more individualized than that.

We might start by looking at the story of your symptoms. When did they begin? What was happening in your life at the time? Do they come and go? Have they moved around? Are there times when you can do something without symptoms that normally causes them? Do symptoms increase when you’re stressed? What have doctors found? What treatments have helped—or strangely helped only temporarily?

We are looking for evidence about what your brain and body are doing. From there, PRT can include several different approaches.

Pain education

Understanding what is happening matters.

If you believe every painful sensation means your body is being damaged, being afraid of that sensation is pretty reasonable.

So part of PRT involves learning about how pain works and, when appropriate, gathering evidence that symptoms may be neuroplastic rather than a sign of ongoing physical damage.

I often have clients create an Evidence List: their own collection of experiences that don’t make much sense under a purely structural explanation but do make sense when we consider the brain and nervous system.

The goal isn’t to blindly convince yourself that everything is fine. It’s to look at the evidence you actually have.

Somatic tracking

Somatic tracking is probably the technique most associated with PRT.

Instead of immediately trying to escape, fix, analyze, or fight a sensation, you practice noticing it with curiosity and as little fear as possible.

Where exactly is it?

Is it pressure? Tightness? Burning? Tingling?

Does it have an edge?

Does it stay completely still, or move?

Can you observe it without needing it to change?

That last question is important.

Somatic tracking can easily turn into staring at a symptom while thinking, Okay, I’m being curious. Why aren’t you gone yet?

I’ve been there. That’s still fear wearing a slightly better disguise.

The goal of somatic tracking is not to force the symptom away. It is to give your brain a new experience with the sensation.

Instead of: Sensation → Danger! → Fear → Fix it!

we are practicing: Sensation → Curiosity → I’m okay → Safety

Over time, those new experiences can help change the brain’s learned response.

Graded exposure

Sometimes the fear isn’t just about a sensation. It’s about the thing you’ve learned will cause it.

Maybe that’s bending over, exercising, eating a certain food, sitting in a chair, driving, walking farther from home, or something else entirely.

Avoidance makes perfect sense when your brain believes something is dangerous. The problem is that avoiding it can also reinforce the belief.

Good thing we didn’t do that. It must have been dangerous.

Graded exposure means slowly and intentionally approaching feared activities while helping the brain experience them through a lens of safety.

This is not “push through the pain.”

It is not throwing yourself into the scariest activity you can think of to prove a point.

It is creating manageable experiences that allow the brain to learn something new.

Working with the nervous system outside of pain

Sometimes the pain itself isn’t the only thing keeping the brain’s danger alarm switched on.

Maybe you spend most of your day worrying. Or putting enormous pressure on yourself. Or criticizing yourself. Maybe uncertainty feels intolerable. Maybe you’re constantly scanning for what could go wrong.

Maybe your body learned a long time ago that it needed to be on guard.

In those cases, we may work with those patterns too.

PRT is ultimately about helping the brain shift from danger to safety, and danger doesn’t only come from physical sensations.

For some people, emotional processing may also become part of the work. Difficult emotions aren’t inherently dangerous, but we can certainly learn that they are. If anger, sadness, fear, or other emotions have become threatening to the nervous system, learning to safely experience them may be another piece of the puzzle.

Is there research behind PRT?

Yes, and this is one of the things that originally made PRT particularly interesting to me.

In a randomized clinical trial conducted at the University of Colorado Boulder, researchers studied 151 adults with primary chronic back pain. Participants received PRT, a placebo treatment, or their usual care.

After four weeks, 66% of the participants assigned to PRT were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% receiving usual care. The improvements were largely maintained one year later.

Researchers also used brain imaging before and after treatment and found changes in brain activity and connectivity associated with pain.

Even more encouragingly, researchers followed participants again five years later and found that the PRT group continued to report significantly lower pain than the placebo and usual-care groups.

This doesn’t mean that 66% of everyone with every type of chronic symptom will recover with PRT. This particular study looked at people with primary chronic back pain. But it does give us compelling evidence that changing the brain’s beliefs about the cause and danger of pain can change the experience of pain itself.

Does this mean my pain is “all in my head”?

No.

And I understand why people hate that phrase.

If your brain produces pain, you experience pain in your body. You don’t experience an imaginary version of it.

The brain and body aren’t two completely separate systems where a symptom has to belong to one or the other.

Think about embarrassment. Nothing physically injures your cheeks when someone embarrasses you, but your face can become hot and bright red.

Think about biting into a lemon—or even vividly imagining biting into one. Your mouth may start producing saliva.

Think about being nervous before speaking in front of a crowd. Your heart might race, your palms might sweat, your stomach might hurt, and you might suddenly need to use the bathroom.

Those physical reactions aren’t fake.

Your brain is extraordinarily good at creating real changes in your body based on what it believes is happening.

That ability isn’t the bad news.

It’s actually the reason PRT can work.

The goal isn’t to become perfectly calm

I think this is an important distinction.

You do not need to eliminate stress from your life to recover from neuroplastic pain. You don’t need to meditate perfectly, think positively all day, heal every difficult experience from your childhood, or somehow become a person who never worries.

That sounds exhausting. And like a lot of pressure for a treatment that is supposed to reduce your brain’s sense of danger.

The goal is to begin changing your relationship with the symptoms and the things your brain has learned to fear.

Fear can become curiosity.

Hypervigilance can become observation.

Resistance can become allowing.

Danger can begin to feel like safety.

Not perfectly. Not all at once. But enough times for the brain to start learning something new.

Is PRT right for every type of pain?

No.

Pain can absolutely be caused by injury, illness, inflammation, infection, structural problems, and other medical conditions that require appropriate medical care.

PRT is not about assuming every symptom is neuroplastic or discouraging someone from seeing a doctor.

Before treating symptoms as neuroplastic, it is important to consider the medical picture and the evidence surrounding those particular symptoms. When there is uncertainty, evaluation by an appropriate medical professional—ideally one familiar with neuroplastic or mind-body conditions—can be helpful.

It is also possible for both things to be true.

Someone can have a structural issue and have a nervous system that has become sensitized and is amplifying the pain associated with it. The existence of an abnormality on an MRI does not automatically tell us how much pain that abnormality is producing.

The question isn’t simply, Did a doctor find something?

It’s: What does all of the evidence tell us about what is driving the symptoms?

Why I love this approach

For years, chronic pain treatment has often centered around finding the thing that is wrong and fixing it.

The muscle. The joint. The posture. The disc. The food. The movement. The chair. The pillow.

When nothing works, it is easy to walk away with an increasingly long list of things your body supposedly can’t handle.

I know that feeling personally. Before finding this approach myself, I spent years trying to understand and treat chronic symptoms that eventually left me largely bedridden and using a wheelchair. Learning about the role the brain and nervous system could play in my symptoms completely changed the direction of my own recovery.

That’s a large part of why I do this work now.

PRT offers a very different possibility:

What if your body isn’t as broken as you’ve come to believe?

What if your brain has been doing its job—protecting you—just a little too enthusiastically?

And what if it can learn something different?

Neuroplasticity means the brain can learn.

Fortunately for us, it also means the brain can relearn.

Wondering if PRT could be a fit for you?

If you recognize some of your own experience in what you’ve read here, I offer free 15-minute connect calls where we can talk a little about your symptoms, what you’ve already tried, and whether PRT might make sense for you.

Schedule a Free Connect Call