Pain reprocessing therapy (PRT) is an approach to pain management that aims to help people rewire pathways in their brain to switch off chronic pain.
There are three types of chronic pain: nociceptive, which occurs from a tissue injury; neuropathic, which occurs from a nerve injury; and nociplastic, which occurs without a clear physical clause, as a response to a sensitized central nervous system and abnormal pain signal processing. Fibromyalgia, irritable bowel syndrome, and nonspecific back pain are potentially nociplastic (and were previously known as functional pain syndromes).
Pain reprocessing therapy uses psychological techniques to retrain the brain to interpret and respond to bodily signals properly. It has five components:
Educating people about the neuroscientific origins of pain, the pain-fear cycle, and the reversibility of pain, allowing them to view this type of pain as completely safe.
Helping people see that their pain is not due to a structural/physical process, but rather a central process, by finding an example of centralized pain in their own lives (pain originating without injury or during time or stress; instances where pain should have been present but wasn't; etc.).
Leading people through exercises to help them change their perception of pain and interrupt the pain-fear cycle, allowing them to see pain sensations through a lens of lightness and curiosity.
Addressing other emotional threats and lowering patients’ overall threat levels, such as by helping them process past trauma and difficult relationships, and correcting psychologically destructive behaviors like self-criticism.
Shifting from a high-threat level “danger mode” to a “safety mode” by encouraging positive sensations and feelings.
Pain reprocessing therapy is a new type of treatment, so little research has been done on its ability to improve various types of chronic pain, except for chronic back pain.
Chronic Back Pain In a groundbreaking and widely reported randomized control trial, researchers carried out the first clinical test of PRT, which included 151 participants with mild to moderate chronic back pain for which no physical cause could be found. Remarkably, two-thirds of patients treated with PRT for four weeks were pain-free or nearly pain-free. And a whopping 98 percent of PRT patients had least some improvement. The outcomes held true a year later.
Another small study had similar findings for a 12-week PRT-like course called psychophysiologic symptom relief therapy. Nearly two-thirds of patients who received the treatment reported being free of the chronic back pain they had experienced.
Though the research on PRT is scant, scientists had previously researched the first component of PRT, called pain neuroscience education (PNE), which seeks to reconceptualize a person’s understanding of pain as less threatening or nonthreatening.
One literature review found that PNE for musculoskeletal pain could reduce pain and patients’ knowledge of pain, which could possibly improve function and lower disability, reduce psychosocial factors, enhance movement, and minimize the need for healthcare utilization.
Pain Catastrophizing, Fear of Moving Another review, however, found that while PNE does not seem to decrease pain or disability, it can help people cope with their chronic pain condition and reduce their pain catastrophizing and fear of moving (or kinesiophobia). And one systematic review compared PNE plus exercise and exercise alone for chronic musculoskeletal pain. It found that incorporating PNE resulted in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing.
Additionally, research has found some support for using PNE to treat specific pain issues when used in conjunction with other therapies:
Spinal pain
Migraine
Lower back pain
Neck pain in adolescents
Other Benefits
It’s not yet known whether pain reprocessing therapy could help with other, non-pain conditions, but there are reasons to be optimistic.
Fibromyalgia-Related Pain and Function Symptoms Research shows that pain neuroscience education may help improve functional status and pain in people with fibromyalgia.
Fear of Movement, Pain Sensitivity In people with osteoarthritis who will be getting a total knee replacement, PNE may help decrease fear of movement and pain sensitivity, as well as increase positive beliefs about their upcoming knee surgery.
Given that PRT focuses specifically on pain, it has little applicability to overall health.
However, research shows that chronic pain and psychological issues are linked. People who have chronic pain are four times more likely to have depression or anxiety than those who are pain-free. Some chronic pain can prevent individuals from various activities, including working outside of their home, going to school, or doing household chores. And the more severe pain people have, the greater their health and lifestyle problems and cognitive impairments.
It stands to reason that relief from chronic pain (via PRT or other methods) can improve psychological health and well-being.
You can find a pain reprocessing therapy practitioner by searching the Pain Reprocessing Therapy Institute’s Clinician Directory. To be included in the directory, the practitioner must receive certification from the PRT Institute.
You can learn about pain neuroscience from a trained physical therapist who has a therapeutic pain specialist certification.
Pain reprocessing therapy commonly involves eight individual one-hour sessions with a PRT certified therapist (twice weekly for four weeks). The therapy sessions cover:
Identifying personalized evidence for centralized pain
Reappraising your pain sensations while seated and while engaging in postures or movements you fear will cause pain
Learning techniques to address psychosocial threats (difficult emotions) that potentially amplify pain
Learning techniques to increase your positive emotions and self-compassion
The cost varies, but psychotherapy providers typically charge between $100 to $200 per session, though reduced or sliding scale rates may be available.
Most health insurance plans cover at least some of the cost of necessary physical therapy and psychotherapy for pain. Medicare, for example, covers 80 percent of the cost of both physical therapy and mental health care. Check with your health insurance provider about the costs of physical therapy and psychological therapy.
