When Pain Persists: Understanding Pain Reprocessing Therapy

Have you ever wondered why some pain just won't go away? Perhaps you've experienced it yourself - a back pain that lingers long after an injury has healed, or a persistent headache that medical tests can't explain. Maybe you've found yourself avoiding playing with your children because of back pain, turning down social invitations due to recurring migraines, or giving up your morning jog due to persistent knee issues. Many of us have been there, feeling frustrated and confused about why our bodies seem to be sending us pain signals when doctors can't find anything physically wrong.

The Mystery of Chronic Pain

Think about the last time you touched something hot. Your hand jerked away almost before you realized what happened, right? That's your pain system working perfectly - protecting you from harm. But what happens when this sophisticated system starts sending false alarms? When buttoning your shirt becomes a daily challenge, or when reaching for a coffee mug makes you wince in anticipation of shoulder pain? This is where the story of chronic pain begins, and where Pain Reprocessing Therapy (PRT) enters the picture.

What Makes Pain "Stick Around"?

Imagine your nervous system as an extremely dedicated security guard. After experiencing an injury or trauma, it becomes hypervigilant, determined to protect you from future harm. Sometimes, even after the original threat is gone, this guard keeps sounding the alarm. Think about how a simple task like gardening or reaching for a cup in your kitchen cabinet can become a source of anxiety. What used to be enjoyable daily activities suddenly feel like risks not worth taking.

This is what we call neuroplastic pain - pain that persists not because of tissue damage, but because your brain has learned to maintain these protective pain signals. Consider how many people find themselves declining dinner invitations because sitting for long periods has become unbearable, or avoiding their favorite hobby because they fear triggering another pain cycle.

The fascinating thing about neuroplastic pain is that while there's no actual physical danger, the pain you feel is absolutely real. Your brain has simply become too good at its protective job, creating a pain response when one isn't needed.

Enter Pain Reprocessing Therapy

Developed by Alan Gordon at the Pain Reprocessing Therapy Center in Los Angeles, PRT takes a revolutionary approach to chronic pain. Instead of focusing on the body part that hurts, it targets the root of the problem: the brain's pain processing system.

Think of it like reprogramming a computer that's running an outdated security protocol. The goal isn't to mask or suppress the pain, but to help your brain update its threat assessment system. Just as you might need to update your phone's software to fix bugs, PRT helps update your brain's pain processing system to work more effectively.

How Does PRT Work?

The therapy combines several key approaches:

1. Education: Understanding why your brain is creating pain when there's no physical danger

2. Somatic Tracking: Learning to observe pain sensations with curiosity rather than fear

3. Pain Reprocessing: Gradually teaching your brain that certain movements and activities are safe

4. Emotional Awareness: Recognizing how stress, anxiety, and past experiences influence pain

Think about someone who once experienced back pain while lifting groceries. Initially, their brain created a protective response - being careful with heavy items. But over time, if this caution becomes excessive - avoiding all lifting, heavy or not, bending, or similar movements - they've developed an unnecessary protective pattern that can lower their quality of life and even make them drop some of their favourite activities altogether. Perhaps they stop going to the gym, avoid picking up their grandchildren, or give up their beloved garden work. PRT helps identify and correct these kinds of learned responses when they're no longer serving a protective purpose.

The Science Behind PRT

A groundbreaking study by Ashar and colleagues at the University of Colorado Boulder, published in 2021 in JAMA Psychiatry, involved 151 participants with chronic back pain and showed remarkable results:

• Participants had been experiencing pain for at least 6 months with a minimum pain intensity of 4 out of 10 on a pain scale

• The study focused specifically on primary pain, which affects approximately 85% of chronic back pain patients - those whose medical tests cannot identify a clear physical cause

• 66% of participants became nearly or completely pain-free after just four weeks of PRT treatment, compared to only 20% in the placebo group and 10% in the no-treatment group

• The improvements lasted for at least one year in follow-up assessments

• Brain scans showed actual changes in pain-processing regions, particularly in the anterior insula and anterior midcingulate cortex, areas known to be involved in pain perception and emotional processing
  

These results provide strong scientific evidence that PRT can effectively reduce or eliminate chronic pain in a majority of patients, while creating lasting changes in how the brain processes pain signals.

The Role of Trauma and the Nervous System

Our nervous system plays a crucial role in how we experience and maintain pain. Past traumas, whether physical or emotional, can leave lasting imprints on our nervous system. These experiences can make our brain more likely to interpret certain sensations as threatening, leading to chronic pain. PRT helps address these patterns by teaching the nervous system that it's safe to release these protective responses.

Beyond PRT: Complementary Approaches

While PRT is powerful on its own, integrating complementary approaches can enhance its effectiveness. Two particularly valuable additions are Emotional Awareness and Expression Therapy (EAET) and the Feldenkrais Method.

EAET focuses on identifying and processing suppressed emotions that might be contributing to chronic pain. For instance, someone might realize their neck pain intensifies during stressful work periods, or their back pain flares up when dealing with challenging family situations. Through EAET, patients often discover connections between their emotional state and physical symptoms, opening new pathways for healing.

The Feldenkrais Method adds another crucial dimension through gentle, mindful movement exploration. Instead of forcing your body into "correct" positions, this method helps you discover easier, more efficient ways to move. Imagine someone who has become stiff and guarded due to chronic shoulder pain. Through Feldenkrais lessons, they might discover that their entire upper body has been compensating and holding unnecessary tension. By learning to move with greater awareness and less effort, they not only reduce pain but also rediscover the joy of fluid, comfortable movement in daily activities like reaching for objects or turning to look behind them while driving.

One of the method's most powerful aspects is its ability to help reset the nervous system. Through slow, gentle movements and focused attention, Feldenkrais lessons can guide your nervous system from a state of heightened alertness (fight-or-flight) to a state of relaxation and balance (rest-and-digest). This shift is crucial for pain reduction, as a calmer nervous system is better able to accurately process sensory information and reduce unnecessary protective responses.

Together, these approaches create a comprehensive framework for healing: PRT retrains the brain's pain processing, EAET addresses emotional components, and Feldenkrais helps restore natural, comfortable movement patterns while regulating the nervous system. This combination addresses chronic pain from multiple angles, supporting lasting change and renewed confidence in movement.

Is PRT Right for You?

Pain Reprocessing Therapy might be particularly helpful if:

• Your pain has lasted more than six months

• Medical tests can't fully explain your pain

• Your pain level changes with stress or emotions

• Traditional treatments haven't provided lasting relief

• You find yourself constantly modifying or avoiding daily activities

• Your social life or work has been impacted by chronic pain

However, it's important to note that PRT isn't suitable for pain from active injuries or diseases. Always consult with healthcare providers to rule out physical causes before starting PRT.

The Path to Pain Freedom

Breaking free from chronic pain isn't just about managing symptoms - it's about helping your brain unlearn pain patterns that are no longer helpful. Through PRT, many people discover that they can retrain their brain's pain processing system and return to activities they thought they'd lost forever.

Remember: your pain is real, but it might not mean what you think it means. With approaches like PRT, there's hope for a pain-free future, even when traditional treatments haven't worked. The key lies in understanding that sometimes, the path to healing pain runs through the brain rather than the body.

Unlearning your chronic pain in Luxembourg

At MindfulBody in Luxembourg, we help you unlearn your pain, reconnect with your body, and discover the freedom of pain-free movement. Our approach focuses on understanding how your nervous system learned to create pain signals, and more importantly, how to help it feel safe again.

We combine Pain Reprocessing Therapy (PRT) with Emotional Awareness and Expression Therapy (EAET) and the Feldenkrais Method to create a comprehensive healing experience. This unique combination addresses the neural pathways of pain, emotional components, and movement patterns that contribute to chronic pain. Through consistent practice of self-awareness and gentle movement, you'll not only heal from current pain but also learn to recognise and prevent unhealthy patterns from developing in the future.

If you'd like to discuss how I could support you on your healing journey, feel free to reach out at iryna@mindfulbody.lu.

References

Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2021). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry, 78(11), 1075–1085