Okay, but does this actually work?
Fair question.
Pain Reprocessing Therapy asks people to consider something that can feel pretty radical at first: that pain they have been feeling in their body, sometimes for years, may not be a sign that their body is damaged. Then it asks them to start responding to that pain differently.
That is a lot to ask someone to take on faith.
Fortunately, you don’t have to.
I get the skepticism more than most. Before I ever learned about neuroplastic pain, I spent years bouncing between doctors, specialists, diagnoses, treatments, medications, and more medical appointments than I care to count (but you know I know the number). At my worst, I was largely bedridden and eventually using a wheelchair. I wasn’t looking for an interesting new theory about pain. I wanted someone to figure out what was wrong with my body and fix it.
If someone had told me early on that my brain and nervous system could be creating or amplifying my symptoms, I’m honestly not sure how well I would have received it.
Actually, I have a pretty good idea.
I wanted evidence. I wanted an explanation that made sense. And I wanted to know that people weren’t just finding a more sophisticated way to tell me to “think positive” about symptoms that were very, very real.
So when I eventually learned about Pain Reprocessing Therapy, the research mattered to me too.
The study that put PRT on the map
The strongest research on PRT so far comes from a randomized clinical trial conducted in Boulder, Colorado. Researchers recruited 151 adults who had experienced chronic back pain for an average of about 10 years and randomly assigned them to one of three groups: Pain Reprocessing Therapy, an open-label placebo treatment, or their usual care.
These weren’t people with a brand-new backache. They had been hurting for a long time.
The people receiving PRT had one telehealth visit with a physician followed by eight treatment sessions over four weeks. After those four weeks, 66% of the people assigned to PRT were pain-free or nearly pain-free, compared with 20% of the placebo group and 10% of the usual-care group.
When I first encountered numbers like these, this was the part that got my attention. Chronic pain recovery stories are powerful. I have one myself. But a recovery story can’t tell us whether a treatment works. A randomized clinical trial can start to answer that question in a much more meaningful way.
And these results weren’t simply about people learning to cope better with their pain. Pain intensity itself changed substantially.
But whenever I see impressive results immediately after a treatment, I want to know what happened later. Did people still feel better when nobody was actively treating them anymore? Did the effect last once they returned to normal life?
At the one-year follow-up, the PRT group was still reporting significantly less pain than either comparison group, with the gains largely maintained. Then researchers went back again. A five-year follow-up published in 2025 included 113 of the original participants, and the people who had received PRT were still reporting significantly lower pain than those who had received placebo or usual care. Among participants who completed the follow-up, 55% of those who had received PRT reported being nearly or completely pain-free.
Five years.
I think that matters.
It also gets at something important about what PRT is actually trying to do. The goal isn’t to teach someone to grit their teeth and become better at living with pain. It’s to change the brain’s interpretation of the signals it is receiving from the body.
What were they actually doing?
Nobody in the Boulder study was being taught that their pain wasn’t real.
That’s an important distinction, because I think “the brain is causing pain” can sound suspiciously similar to “the pain is in your head” when you first hear it. Having been on the receiving end of medical explanations that didn’t seem to account for what I was actually experiencing, I understand why people bristle at that.
PRT starts somewhere very different. Pain is real. The question is why the brain is producing it.
The researchers described PRT as helping participants understand their pain as arising from nondangerous brain activity rather than ongoing tissue injury, and then used cognitive, somatic, and exposure-based techniques to help reinforce that understanding.
In normal-person language: they were helping the brain learn that the pain did not necessarily mean danger.
Not: I don’t feel this.
But: I feel this, and I don’t believe it means I’m hurting myself.
Those are two very different things.
That distinction is also why PRT involves more than simply learning the science. I can explain neuroplastic pain to someone for an hour, and they may understand every word I said while their entire nervous system still screams ABSOLUTELY NOT when they bend forward and their back hurts.
That’s where the actual work becomes individual.
With one person, we might discover that they’ve become afraid of a particular movement. Someone else is checking their body fifty times a day without realizing it. Another person intellectually believes their pain could be neuroplastic but still panics every time it increases. Someone else has ten years of medical experiences telling them that their body is fragile, and it would be ridiculous to expect one reassuring conversation to undo that.
That’s the gap PRT is trying to work with: the difference between intellectually understanding that you may be safe and actually giving your brain experiences of safety.
So, does PRT actually work?
For chronic primary back pain, we have a well-designed randomized trial showing substantial pain reduction, with benefits that were still detectable five years later. For other conditions, the PRT-specific research is much earlier, and there is still a great deal we don’t know.
That’s the answer I would have wanted when I was sick.
Not this works for everyone.
Not your symptoms are definitely neuroplastic.
Not here’s one incredible study, so stop asking questions.
I would have wanted someone to sit down with me and say: There is real research behind this. Here’s what we know. Here’s what we don’t know. And now let’s look at whether any of it actually fits your story.
Because ultimately, that’s the part a research paper can’t answer for you.
It can’t tell us why your back hurts at work but barely bothers you on vacation. It can’t tell us what it means that your symptoms began after an injury but continued years after the injury healed. It can’t tell us whether the fact that your pain moves around is significant, whether you’re afraid of a particular movement, whether you have structural findings that need to be taken seriously, or whether you’ve already noticed moments when your symptoms behave in ways that don’t quite make sense structurally.
Those are the conversations I have with clients.
I don’t need someone to arrive already convinced that their symptoms are neuroplastic. In fact, I expect some doubt. We’re talking about asking your brain to reconsider something it may have believed for years: Pain means something is wrong with my body.
That’s not a belief I expect anyone to abandon because they read one blog post.
We look at the evidence together.
Sometimes there are strong clues that the nervous system may be playing a significant role. Sometimes the picture is messier. Sometimes there are questions that need to go back to a medical provider. And sometimes the person sitting across from me understands neuroplastic pain perfectly well but still says, Okay, I get all of this. But when my pain shows up, I still believe something is wrong.
Good.
Now we know where the work is.
For me, that’s where the hope in the research lives. Not in a promise that PRT will work for every person or every symptom, but in evidence that pain is not always the fixed readout of a damaged body that many of us were taught to believe it was.
The nervous system can change.
I know what it is like to need evidence before you’re willing to entertain that possibility. I also know what it is like when the possibility finally begins to make sense.
Wondering whether PRT could apply to your symptoms?
If you’re wondering whether your own symptoms might have a neuroplastic component, you can start with my free Neuroplastic Symptoms Self-Assessment or read How Do I Know If My Symptoms Are Neuroplastic?
And if you’d rather talk it through with a real person, I offer free 15-minute connect calls where we can talk a little about what you’ve been experiencing, what you’ve already tried, and whether PRT might make sense as something to explore.
Original PRT randomized clinical trial:
Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13–23.
Read the original PRT study in JAMA Psychiatry
Five-year follow-up:
Ashar YK, Low EL, Knight K, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025;82(10):1049–1051. At five years, 55% of PRT participants who completed follow-up were nearly or completely pain-free, compared with 26% in placebo and 36% in usual care.
Read the 5-year follow-up in JAMA Psychiatry
About the Author
Amberleigh Maida, ICF-ACC, is an Advanced Pain Reprocessing Therapy (PRT) Practitioner with additional training in Emotional Awareness and Expression Therapy (EAET). Having experienced and recovered from years of debilitating chronic pain herself, she brings both professional training and lived experience to her work. She also holds a master’s degree in creative writing with a focus on nonfiction. Through her writing, she explores neuroplastic symptoms, the brain-body connection, and evidence-based approaches to chronic pain and other persistent symptoms.
Learn more about Amberleigh’s personal story and approach or explore her professional credentials and training.
