Pain Reprocessing Therapy (PRT)

What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy (PRT) is a psychological treatment for chronic pain. It is based on the understanding that pain is not only a physical sensation but also a protective response, the nervous system interpreting signals from the body as dangerous.

Over time, the brain and nervous system can become conditioned to associate certain body areas with danger, even after an injury has healed. For example, if you injure your knee, it may take a few months for it to physically recover, however the nervous system can continue to associate that part of the body with pain, even when there’s no ongoing damage which fully explains the severity of symptoms.

PRT helps to retrain the brain to interpret these sensations as safe. This is done through pain education, guided somatic exercises, and learning to respond to symptoms with a sense of calm and safety. This helps to reduce the nervous system’s threat response and, in turn, reduce pain.

What does Pain Reprocessing Therapy Involve?

Pain Education

PRT involves understanding how chronic pain works. Many people living with persistent pain understandably believe that pain must mean ongoing physical damage. PRT helps you learn about the role of the brain and nervous system in generating and maintaining pain. This also helps you identify indicators of neuroplastic pain, pain which occurs as a result of a learnt nervous system response rather than ongoing structural damage. This in itself can provide a useful psychological reframe from “My body is damaged” to “My nervous system has become overprotective”. These indicators include pain which is inconsistent, for example it shows up during an activity at some times, but is absent during the same activity at others. Pain may also move around, for example, in chronic back pain, an individual may notice symptoms on one side of the the lower back at times, and on the other side at others. These patterns suggest that the nervous system has become sensitised and is responding to perceived danger rather than injury alone.

Exposure to Feared Sensations

As previously mentioned, over time with persistent pain, our nervous systems begin to associate sensations with danger, amplifying them. PRT helps you notice these sensations with less fear and avoidance through exercises such as somatic tracking. Over time, this can help to retrain the nervous system to interpret these sensations as safe rather than dangerous.

Emotional Awareness

Through learning more about the mind-body connection, PRT learns help youidentify how stress, frustration, and suppressed emotions can show up in the body and amplify symptoms. Treatment may involve helping you become more aware of how emotional responses interact with physical symptoms.

This doesn’t mean that pain is “all in the mind”, for people living with chronic pain, symptoms are very real when they shows up in the body. Instead it aims to help you to become more aware of how emotions and physical symptoms are connected.

Gradual Return to Avoided Activities

Pain causes people to avoid certain movements and activities. However, for many, these activities are often important in day-to-day functioning and living a meaningful life such has work, exercise, hobbies, or social activities. PRT helps you gradually return to these activities in a way that allows your nervous system to relearn that they are safe, reducing anticipatory fear and pain during them.

How Do I know Pain Reprocessing Therapy Works?

A 2021 study published in JAMA Psychiatry found that among patients with an average of 10 years of pain, 66% were pain-free or nearly pain-free following treatment. Scans also showed a significant reduction in activity in areas of the brain associated with pain and threat processing.

Who might benefit from Pain Reprocessing Therapy?

While most of the research has focused on chronic back pain, PRT may be helpful for managing pain associated with a range of conditions such as; Fibromyalgia, Irritable Bowel Syndrome (IBS), Osteoarthritis, chronic back, neck pain and pelvic pain, tension headaches, migraines, non-cardiac chest pain, pain following injury or surgery that persists after healing and medically unexplained pain or symptoms.

PRT is often most appropriate when symptoms have been medically assessed and there is no ongoing tissue damage that fully explains the severity or persistence of symptoms. It can also be helpful if you have become fearful of pain or have found that pain is restricting activity and limiting your ability to live a meaningful life.

How can PRT Help Treat These Conditions?

A key factor which is believed to contribute to fibromyalgia is central sensitisation. Essentially, this means that the nervous system becomes increasingly sensitive, amplifying pain signals.
A helpful analogy is to think of the nervous system as a volume control. For someone without chronic pain, the volume may be set at a 4 out of 10. For someone with fibromyalgia, it may be turned up to an 8 or 9. As a result, sensations that would normally be interpreted as safe can be experienced as painful or threatening.
PRT works to help the nervous system gradually learn that these sensations are safe. Through education, somatic tracking, and a gradual reduction in fear around symptoms and activity, the nervous system can become less sensitised over time, helping to "turn down the volume".
For some individuals with IBS, symptoms can seem inconsistent. Certain foods trigger symptoms at some times but not others, while stress and anxiety can also play a role in flare ups.
This may lead them to extremely restrictive diets, or to feel anxious at the prospect of symptoms showing up in certain situations. Over time many people become hypervigilant to sensations in their stomach and digestive system, monitoring for signs that symptoms may be showing up. While this is understandable, it can lead to an increase in anxiety which may amplify discomfort and contribute to the pain-fear cycle.
The gut is often described as “the second brain” because of its connection with the nervous system. PRT can help people understand this connectionand provide strategies to reduce fear around symptoms.
After an injury or surgery, while an MRI scan may show that the tissue has healed, pain can persist when the nervous system hasn’t learnt that movements and sensations are no longer causing damage in the body. PRT helps to understand this process, emphasising that the individual is no longer doing themselves damage, before using techniques such as somatic tracking and gradual exposure to avoided activities to help the nervous system relearn that these activities and sensations are safe.
Stress, nervous system activation, and fear of symptoms and triggers can play a key role in headache severity and frequency. Many people may begin closely monitoring for signs of a headache beginning or avoiding situations which could trigger symptoms. PRT can help recognise patterns in symptoms and to reduce fear around headaches, helping individuals respond in a calmer and more flexible way.
This may look out of place here, you may be thinking “but osteoarthritis is a structural condition that shows up on scans?”
While this is true and osteoarthritis involves changes in joints can certainly contribute to pain. Research has found that it’s not as straightforward as “structural changes = pain”. A large population study found that only 47% of individuals with radiographic evidence of knee osteoarthritis reported knee pain (Hannan et al., 2000).
This doesn’t mean that joint changes are irrelevant. Rather, it suggests that pain can be influenced by multiple factors, including how the nervous system interprets and responds to signals from the body. PRT aims to address the nervous system’s role here, helping to reduce fear around pain and movement, supporting a gradual return to activity.

Important Note

This does not imply that the pain experienced in any of these conditions is imagined. The pain is real. However, in many cases, pain may be influenced by the way the nervous system processes and responds to signals from the body. By helping you understand this process and respond to symptoms with less fear, PRT aims to reduce the nervous system’s threat response and support recovery.

How to Get Started

If you are interested in Pain Reprocessing Therapy or would like to find out whether it may be appropriate for your symptoms, please get in touch. We would be happy to answer any questions you may have and discuss whether PRT could be helpful for you.

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