What is Pain Reprocessing Therapy and how can it help chronic or persistent pain?

What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy (PRT) is a relatively new way of working with people with persistent pain, but is based on some old ideas going back to the work of John Sarno (Healing back pain; The mind body solution; The Divided Mind).  However, some of those old ideas have been updated and, crucially, a Randomised Controlled Trial (RCT) – the ‘gold standard’ in research – has recently shown just how effective this therapy can be (Ashar, Gordon, Schubiner et al, 2021).

PRT is based on the idea that persistent pain (and other symptoms) can be created or exacerbated by learned neural pathways in the brain rather than from damaged tissues in the body.   This type of pain is commonly referred to as ‘neuroplastic’, but other terms used interchangeably in the literature include mind-body symptoms and psychophysiological problems. Dr Howard Schubiner, one of the experts in this field, estimates that up to 90% of persistent pain is actually neuroplastic.  Pain is pain, and neuroplastic pain is no less real than pain caused by tissue damage.  It simply has different origins. 

Photo by Ronak Valobobhai on Unsplash

Wrapping your head around it all…..

This might initially seem like a really strange idea to wrap your head around.  However, we all experience neuroplastic symptoms from time to time.  Have you ever found a letter in your children’s schoolbag asking you to check for lice as someone in the class has them – and found your head itching?  Have you ever started to feel nauseous when someone you spent yesterday comes down with a stomach bug, even if you turn out to be fine?  The most famous example of neuroplastic pain is the ‘nail in the shoe’ story, written about in the British Medical Journal in the 1990s.  A construction worker jumped off a pallet on to a large nail, which protruded through his shoe.  He was in agony, and taken to hospital, and given strong medication.  When his boot was removed, however – the nail had gone between his toes, causing no damage whatsoever.  However, his brain decided to produce pain as a warning signal, as his brain perceived his foot had been damaged. 

Pain as a protector

You see, that’s what pain is.  It’s a protector.  It helps us prevent further damage or harm.  If we place our hand on a hot surface, we are really glad that pain protects us to help us take action.  Pain is really strange and is always a biopsychosocial phenomenom (i.e. pain is made up of things in our biology, our psychological processes such as beliefs, stress levels and past experiences, and the way we have learnt to filter information, and social factors, such as work, finances, and relationships).  On occasion,our brains overreact, or make an exaggerated danger signal – i.e. pain (or other strange physical symptoms, such as nausea, itching, dizziness, gastrointestinal problems, interstitial cystitis, tinnitus or migraines, to name a few).  It is simply a way of our body expressing distress, or responding to danger.

What does PRT entail?

PRT is based on research in medicine, neuroscience and psychology, and it is a psychological approach that helps people to reprocess pain experiences as neutral, safe, or nondangerous.  With practice, this can eliminate or reduce persistent pain.  PRT also involves a great deal of pain education, helping people to understand that pain is so much more than ‘issues in the tissues’, to normalise diagnoses or scan results they may have received, and dovetails with contemporary neuroscientific understanding of pain.  PRT also involves teaching lots of different ways of helping the nervous system to feel safe, through relaxation, meditation, visualisation, and messages of safety.  Written exercises can also be helpful to process suppressed (or repressed) emotion, which can have dramatic improvements on pain. 

Not just ‘living with pain’

Our understanding of pain has moved on considerably in the last 20 years.  We no longer just tell people they must ‘learn to live with pain’.  Recovery from pain is possible, and many people can significantly improve their pain, even if it does not resolve, with this therapy. 

Want to know more?

If you would like to read more, Alan Gordon’s ‘The Way Out’ is a very accessible place to start.  You can try a free trial of the Curable app, which has packaged PRT very concisely.  Other websites which may be of interest are:





We’re here to help

We now have a number of Retraining Pain clinicians trained in PRT and we have seen some fantastic results from our clients.  If you think we could help you or one of your clients, say hello at info@retrainingpain.co.uk