What Is Pain Reprocessing Therapy?

Did you watch Dr Chatterjee’s recent Channel 4 Documentary, Live Well with the Drug Free Doctor, which featured Living Proof Ambassador, Fiona’s story of recovery from chronic pain? The documentary shone a much-need light on persistent pain, which affects an estimated 28 million people in the UK. It raised hope for recovery using neuroplastic (or ‘mind-body’) approaches, including Pain Reprocessing Therapy. If you are curious about this therapy and want to learn more, this blog is for you.

In a nutshell….

… Pain Reprocessing Therapy (PRT) is a structured, brain-based approach to treating chronic pain and persistent physical symptoms. It was developed by Alan Gordon, a US-based psychotherapist who specialises in chronic pain recovery. The approach is grounded in modern neuroscience and offers a new way of understanding why pain can persist long after the body has healed. Perhaps most importantly for people living with chronic pain, it offers a treatment path for reducing and resolving symptoms – and real hope for healing.

PRT is often used as part of a broader mind-body approach to healing, which encompasses other techniques, such as emotional awareness and processing, that are all grounded in the same neuroscience and complement one and other.

Who is Pain Reprocessing Therapy Suitable For?

A key part of PRT is learning to distinguish between different types of pain:

• pain caused by current injury or illness

• and pain driven by learnt neural pathways and nervous system dysregulation

  
  

PRT is suitable for the latter type of pain, which is often referred to as neuroplastic pain.

In many cases, persistent pain is not caused by an ongoing structural problem or organic illness (although this should always be ruled out with your doctor). Instead, chronic pain is often sustained by learnt neural circuits: the original physical problem has resolved, but pain continues because the brain and nervous system have learned to interpret certain sensations as dangerous. When the nervous system remains stuck in ‘threat mode’, it can keep generating real and debilitating pain and symptoms— even in the absence of harm.

How Pain Reprocessing Therapy Works

Pain Reprocessing Therapy is a structured programme of psychological and somatic techniques designed to retrain the brain’s response to physical sensations that have become associated with danger.

Rather than trying to manage or push through pain, PRT aims to reduce the brain’s perception of threat. This includes the sense of danger surrounding symptoms – as well the feeling of threat in life more generally. The therapy helps people nurture a stronger sense of overall safety. This is because pain is often the brain’s protective response to perceived danger, both physical and psychosocial or emotional.

Key Components of Pain Reprocessing Therapy

PRT typically includes several core elements:

1. Neuroscience education

Clients learn how chronic pain works. Understanding that all pain is generated by the brain — and does not always mean damage — helps dismantle fear, which is one of the main drivers of chronic pain.

2. Evidence collection

People are guided to gather personalised evidence that their pain is not structurally caused. This might include noticing inconsistencies in symptoms, pain that moves or changes, or that flares during or after stress.

3. Addressing emotional and psychological threats

PRT recognises that psychological stressors — such as self-pressure & criticism, as well as unresolved emotional stress— can keep the nervous system in a heightened state of threat and contribute to ongoing pain. A key part of PRT is addressing such threats that might be fuelling the pain response.

4. Somatic tracking

This involves mindfully exploring bodily sensations with curiosity and safety (rather than fear and danger). By observing sensations without reacting to them as dangerous, the brain learns that these sensations are not a threat, helping to break the pain-fear cycle.

5. Leaning into positive sensations

PRT helps retrain the brain to notice and gravitate toward neutral and positive bodily sensations and experiences, rather than constantly scanning for symptoms and threats. Leaning into nice and neutral sensations can support a felt sense of safety in the body to promote healing.

6. Returning to feared activities

People gradually and safely return to activities they may have been avoiding due to pain, using a structured and nervous-system-informed approach that reinforces safety rather than fear.

The Goal of Pain Reprocessing Therapy

The overarching goal of PRT is to lower the threat level in the brain, which relates to chronic symptoms — and, often, to life more broadly. By retraining the brain away from fear and hyper-focus on symptoms and toward a greater sense of safety, the vicious cycle of pain-fear can be interrupted. Over time, these shifts can lead to lasting relief from chronic pain, rather than short-term symptom management.

The Evidence Behind PRT

Scientific research increasingly supports Pain Reprocessing Therapy as a chronic pain treatment. Notably, this includes randomised controlled trial evidence in chronic back pain:

1.     Ashar et al. (2021) – Randomized Controlled Trial in JAMA Psychiatry

This landmark study compared Pain Reprocessing Therapy with both placebo and usual care in adults with chronic back pain. Results showed that 98% of those who received PRT experienced improvement, with 66% reporting little to no pain by the end of the treatment period. These significant benefits were largely sustained at a one-year follow-up. PRT was also shown to affect brain activity related to pain processing — providing evidence that targeting the nervous system can reduce chronic pain. 

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. doi:10.1001/jamapsychiatry.2021.2669

2.     Ashar et al. (2023) – Secondary Analysis of PRT Mechanisms

A follow-up analysis of the same clinical trial found that PRT led to significant increases in patients attributing their pain to mind-brain processes rather than structural damage. This shift in understanding was associated with reductions in pain intensity, supporting the idea that changing beliefs about pain may be a key part of how PRT works. 

Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023;6(9):e2333846. doi:10.1001/jamanetworkopen.2023.33846

Beyond Pain

Although it was originally developed for chronic pain, Pain Reprocessing Therapy can be applied to a wide range of persistent, unexplained or neuroplastic symptoms. The brain through the automonic nervous service can generate a wide range of symptoms in response to threat. These may include fatigue, dizziness, brain fog, tinnitus, digestive issues, fibromyalgia, migraines and more.

Where to Learn More About Pain Reprocessing Therapy

If you’re interested in learning more about Pain Reprocessing Therapy, there are a growing number of evidence-based resources available.

• The Way Out, a book by Alan Gordon, LCSW and Alon Ziv, outlines the science behind PRT and provides a step-by-step plan for re-training the brain to treat chronic neuroplastic symptoms. 

• The Pain Reprocessing Therapy Center offers learning resources and practical tools to help individuals understand and treat neuroplastic symptoms along with a directory of PRT practitioners for anyone seeking individualised support.  

• ​The Pain Reprocessing Therapy podcast shares neuroscience insights, personal recovery journeys and tools to help rewire the brain's response to pain.

• The Pain Reprocessing Therapy Workbook by Vanessa Blackstone & Olivia Sinaiko provides practical techniques and exercises to re-train the brain. 

• The Pain Reprocessing Therapy Workbook for Teens offers an engaging and interactive workbook for retraining the brain and relieving chronic pain specifically for teens.

• The Curable app for mind-body recovery includes brain-training practices along with pain science education - all accessible on your phone. You can access a free trial of this app via our affiliate relationship with Curable health.

• Many other mind-body healing pproaches incorporate PRT techniques, including Dr Howard Schubiner's book, Unlearn Your Pain and Georgie Oldfield's book, Chronic Pain: the Key to Your Recovery.

  
  

To sum up…

Once structural/organic causes for symptoms have been ruled out by experts, PRT offers a powerful, evidence-informed way forward for people with debilitating chronic symptoms, who may have been left feeling helpless and hopeless following traditional care.

The approach centres on viewing symptoms through the lens of the brain - and on addressing them at the nervous-system level.

Using PRT techniques within a broader neuroplastic approach to recovery, thousands of patients across the world are achieving life-changing and lasting relief from debilitating chronic symptoms.