What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy is a research-backed method of treating chronic pain, specifically neuroplastic pain (read my post on neuroplastic pain to learn more). Because neuroplastic pain is caused by a misinterpretation of the brain, it is treated by rewiring the neural circuits of the brain. 

This process is not a quick fix or a miracle drug. The beautiful thing is that there are no side-effects but it does mean that you have to put in the work of rewiring the brain. 

Now how does that work? How do you rewire the brain? 

For some this is easy. In Dr. Sarno’s book, “Healing Back Pain: The Mind-body Connection”, he talks about how some people were cured of chronic pain simply by reading his book. They merely needed to know that their condition is due to neuroplastic pain and that there really was nothing wrong with their body. 

For others, it is more difficult. This is where the majority of people fit in.  Especially if the pain has lasted for years or decades, it will take time to essentially “unlearn” the pain. 

Pain Reprocessing Therapy

Pain Reprocessing therapy (PRT), a term coined by the Pain Psychology Center, has built upon the work of Dr. Sarno by creating effective methods of rewiring the brain. These methods were tested during the Boulder Back Pain Study. As a result of the study, 66% of the participants who were assigned to the PRT group were pain-free or nearly pain-free and 98% had some reduction in pain. After a year the results still held. Which is incredible when you think about how these people had pain for years, and, in some cases, decades. 

There are five components of PRT including:

  • Education about pain science
  • Attending to sensations through a lens of safety, 
  • Gathering personal evidence
  • Addressing other emotional threats
  • Gravitating toward positive sensations


PRT is different than other psychological methods of healing pain because the emphasis is on psychoeducation. An important part of healing is understanding what is causing the brain to create and perpetuate the pain. Understanding that the pain is not caused by a structural problem allows you to find “chinks in the armor” or times when the pain is not consistent with structural pain. Finding more and more evidence of neuroplastic pain helps the brain to realize that the sensations are safe. 

Attending To Sensations Through a Lens of Safety

A major goal of Pain Reprocessing Therapy is decreasing the fear around the stimulus of pain. People who have chronic pain often get caught in a pain-fear cycle. For example, growing up I heard so many messages about how herniated discs in the spine create pain. I saw people close to me that had bulging or herniated discs, and their pain never seemed to go away. 

When I started having back pain myself, my brain was already primed to think that this pain would not go away. Then I received the MRI results that I had two bulging discs in my spine.

That terrified me. 

Looking back, as the fear surrounding the pain increased, the pain itself increased. I remember many nights not being able to sleep stuck thinking about how the pain was never going to go away. It was at this time that my pain was the worst. 

I wasn’t sure if it would ever go away.

The reason this happens is that pain is a danger signal, usually signaling that there is a problem in the body but can make mistakes. When the fear around the pain increases, the pain increases. Then, when the pain increases, the fear increases creating the perfect storm to keep a person in chronic pain. 

PRT uses various techniques to reframe the story around the pain and reduce fear. Examples of this include changing thoughts of fear into thoughts of safety by “talking” to the brain (essentially telling yourself that you are safe). Even just receiving a diagnosis of neuroplastic pain can decrease fear. A lot of the fear that perpetuates chronic pain is related to the fear of something physiologically wrong and when that is taken away the fear decreases.


Another effective approach to decrease the fear surrounding pain is to practice mindfulness. Mindfulness, put simply, is bringing one’s attention to the present moment. 

So much of the time, especially among chronic pain sufferers, is spent ruminating about the past or anticipating a future that hasn’t happened yet. For me, I would constantly either relive events leading up to my injury or worry about activities that I might not be able to do in the future. This kept my brain in a constant state of high alert and when the brain is in high alert. 

When the brain is in a state of high alert the sympathetic nervous system is activated. This is the branch of the autonomic nervous system that responds when you are in fight or flight. Evolutionarily the sympathetic nervous system takes over when you are in a stressful situation, such as running away from a bear. In a sympathetic state, blood pressure increases, heart rate increases, and stress hormones such as cortisol are released. 

This is a great reaction when you need to run away from a bear but not so much when you are trying to go to sleep but you can’t seem to stop worrying.

When the brain is constantly in a sympathetic state it never gets a chance to be in the parasympathetic state–the state where the body is able to rest, digest food, repair the body and relax the mind. 

Practicing mindfulness keeps the brain in the present moment. In this example, the brain would know that it is safe in bed and that there is nothing to worry about. 

Gathering Personal Evidence

Along with education about chronic pain in general, it is important to have a strong conviction that your pain is neuroplastic and not caused by structural problems. This can be done by creating your own evidence sheet. 

You can do this by making a list, either on a piece of paper or electronically, of evidence that your pain is neuroplastic. This can include some of the signs of neuroplastic pain or times that you have found when you don’t feel pain. For example, maybe you get back pain when sitting but you noticed that you did not feel pain when you were watching one of your favorite TV shows. That experience could go on your list.

Then you can review your list periodically when you need a reminder. Especially if you have been given a diagnosis it is important to continually reinforce the fact that the pain is neuroplastic. 

The important thing, however, is not to approach this with a sense of intensity. You don’t have to write down every example that you find. The point is simply to be curious and to shift your perspective of the pain.

Addressing Other Emotional Threats

Addressing emotional threats can be done in a variety of ways. If there has been a lot of psychological traumas in the past, it may be best to meet with a therapist. If not, talking through emotions with a coach may be all that is needed. For others, journaling may be the best method. Regardless of the approach, it is important to shift the focus from the physical to the emotional. 

For me, something simple that really has helped is journaling about my emotions. Early on in the process of healing, I would journal about my day through the lens of my emotions. Linking how I felt each day with my symptoms helped me to see the connection.

Leaning Into Positive Sensations

Mindfulness can also help cure chronic pain by focusing on positive sensations throughout the day. So much of the time when we are in pain that is all the brain is focused on. By focusing on positive sensations, it trains the brain to focus more on these positive feelings and less on the pain. 

Positive sensations could include focusing on the sensation of the breath coming in and out, the feeling of warm water during a shower or a bath, the taste of food as you are eating, or really anything else that is enjoyable to you.

It can also include leaning into positive emotions. Noticing times when you are feeling positive, joyful, or any other emotion is important to help the brain focus more on those emotions.

Take the Next Step to Get Out of Pain

If you would like to learn more and find out if your pain could be neuroplastic schedule your free 30-minute consultation and find out if Pain Reprocessing Coaching could help heal your pain.

What is TMS, Neuroplastic Pain, or Mindbody Syndrome

TMS, Neuroplastic Pain, and Mindbody Syndrome are essentially different names for the same thing. TMS is the term created by John E. Sarno while the other terms have been commonly used by other practitioners. To understand neuroplastic pain, it is important to first understand what general pain is.

Types of Pain

Pain, put simply, is a perceived danger communicated from the body to the brain in response to a stimulus. For example, if you are on a run and break your ankle, the pain will do its job and communicate with your body not to keep running and risk further injury. Generally, receptors in the body communicate with the brain to keep us safe. 

 Pain can be categorized into the following:

  • Acute pain: pain that resulted from a recent injury. Usually lasts days to weeks.
  • Chronic pain: pain that has continued past the normal period of healing (usually around 3-6 months. 
  • Nociceptive pain is pain that originates from actual tissue damage
  • Neuropathic pain is pain that results from damage to nerves.

Neuroplastic Pain/ TMS

Neuroplastic pain is different from the other types of pain in that it is not associated with actual structural damage. It develops when the brain makes a mistake and perceives an injury when there is none or when pain persists after the initial injury has healed. Neuroplastic pain is the perception of danger (or damage to the body) and not an actual danger that causes pain. 

One famous example of neuroplastic pain is the story of a construction worker who got injured on the job (Fisher et al, 1995).  While working, the worker jumped onto a plank and a 7-inch nail pierced all the way through the bottom of his boot and protruded out of the top of the boot. When he looked down and saw the protruding nail, he was in excruciating pain. He was quickly taken to the ER at which point the doctor took off the boot and found that the nail had gone in between two of his toes. He had no structural injury yet felt an extreme amount of pain! In this situation, his brain had perceived the nail, misjudged that there must be damage, and produced a very real pain.

Personally, I have had the opposite happen to me. I remember one day running early in the morning when it was still dark with my high school cross country team. We were running through an intersection that was still under construction and I tripped and fell on my knee. The group I was with did not notice that I had fallen and I felt fine so I just got up and kept running. 

It wasn’t until we got back to the school and the sun had begun to rise that someone pointed out that I was bleeding. I looked down at my knee and saw a fairly large gash on one of my knees as well as cuts down both of my legs. It was at this point that I finally felt pain. Even though the injury had occurred at least 30 minutes before, I had been enjoying my run and didn’t feel the pain until my brain realized that there was damage.

Both of these examples show that the brain, although generally good at its job, can make mistakes.

Neuroplastic pain can also come on because of a general state of fear or an overstimulated sympathetic nervous system response (the branch of the nervous system responsible for protecting us from imminent danger). There doesn’t have to necessarily be a perceived initial injury. The pain may be a response to fear and fear can cause the pain to perpetuate.

This stress can either be caused by a stressful situation (either happy or sad) or could be brought on because of general stress in a person’s life. This is why people who have certain personality characteristics such as conscientiousness, people-pleasing, or anxiousness have a higher chance of developing neuroplastic pain as well as those who have experienced childhood trauma. When the brain is already on high alert, as it is in times of stress, it is more likely to mistake safe signals in the body as dangerous. 

Signs Chronic Pain is Neuroplastic

How To Treat Neuroplastic Pain

Because neuroplastic pain originates in the brain, not the body, the treatment must target the brain. Treatment can include education in the neuroscience of pain, journaling, mindfulness exercises, and, in cases of unresolved trauma, psychotherapy. The most important thing that all of these treatments target is the fear surrounding pain. Fear is what is causing the brain to be kept in a high-alert state and perpetuates the pain. 

If you would like more information and help on where to start click the link below to schedule a free consultation with me!

References: Fisher JP, Hassan DT, O’Connor N. Minerva. BMJ. 1995 Jan 7;310(70).

My Healing Journey

I first learned about neuroplastic pain by sheer serendipity. After having suffered from midback pain for nearly three years, I came across Dr. Sarno’s book, “Healing Back Pain: The Mind-Body Connection”, while browsing the front bookshelves in my local library. On the front cover, the book made bold claims such that back pain could be cured without surgery, medications, or exercises. Although I was suspicious, I was equally curious, so I checked the book out and began to read.

My back pain started while I was in nursing school and working as a CNA (certified nursing assistant). While I was transferring a patient I felt a sharp pain in my back. Although I had experienced back pain at work before, usually the pain would go away within minutes or rarely by the next day. 

This pain was different.

By the next morning, even picking a sock up off of the ground caused excruciating pain in my back. Due to the severity of the pain, I ended up quitting my job and went to a chiropractor for treatment. 

At first, the treatment seemed to work and I was nearly pain-free for a few months but the pain returned. Over the next few years, the pain would go away for a while but then come back.  I always came up with a physical reason for why it was aggravated (I lifted too much at work, I lifted my niece over a holiday, I sat too long). 

After about a year and a half since the original injury the pain came up this time accompanied by tingling in my legs and feet. These new symptoms were alarmed me…espicially after a few google searches served to increase my anxiety. 

I decided to go to a new chiropractor who specialized in chronic back pain. He sent me for an MRI that confirmed sneaking suspicions that I had over the years. I had two bulging discs in my thoracic spine. 

Although the imaging confirmed my worries, my chiropractor was optimistic and claimed that I could be fully healed. With this new optimism, I was dedicated to this new therapy. I followed every recommendation to the T including icing my back every hour, wearing a muscle stimulator, doing a myriad of exercises and stretches, and coming to see him three times a week. 

This continued for a year until I became frustrated by how much effort I was putting in and the lack of progress. Not only would my pain come back with a vengeance after brief periods of relief, but I was starting to have other pains come up when the chiropractor mentioned that other areas seemed tight, alluding to other potential problems. 

It was at this point that I found Dr. Sarno’s book.

As I began to read the book, I realized how much my situation resembled other people who had been successfully cured by Dr. Sarno. In his book, he spoke of how neuroplastic pain (he used the term “TMS”) can be caused by repressed anger and is often associated with people who are high achieving and hypervigilant.

Since his book is mostly focused on back pain, he also went through the common abnormalities of the spine that pain is often attributed to (including bulging discs) and how the majority of them are actually “normal abnormalities” of the spine associated with aging that should not cause pain. 

Although, as a physician, he made a good case for his claims, I was still skeptical. I wondered, especially with a medical background myself, how this could be true when the prevailing message is that spinal stenosis, bulging discs, and disc herniations are responsible for pain. 

After some research online I found another book, “The Way Out” by Alan Gordon, that offered more evidence for the mind-body approach. Alan’s book showed current research, including a recent clinical trial proving the effectiveness of a mind-body approach to treating pain. 

I realized that my pain did come on during a time of stress, my pain was worse at certain times of the day, and it improved during times of less stress—all of which are signs of neuroplastic pain. The personality traits associated with neuroplastic pain—conscientiousness, people-pleasing, and hypervigilance—were also a match. 

With new confidence in the mind-body method, I decided I would give it a try. After all, what did I have to lose? Thanks to a combination of journaling, meditation, yoga, psychoeducation, and working with a coach, I am now nearly pain-free and have been for the longest duration since my original injury.

During the process, I also learned that the migraines I had been having my whole life and repetitive stress injuries I attributed to running could also be treated the same way. All of these pains are virtually nonexistent now. When I do get pain, I now know what to do about it, and it never lasts long. 

Not only is my pain gone, but I have noticed other side benefits since beginning this journey. I’ve learned how to better deal with and prevent stress, be present, and find more enjoyment in my life.

After my recovery, I decided that I wanted to help others overcome their chronic pain. Through the Pain Psychology Center, I completed a certification in pain reprocessing therapy and offer coaching rooted in the principles taught in “The Way Out”. 

If you have chronic pain and would like to learn more I would highly recommend checking out the books mentioned or to schedule a free consultation by clicking on the link below.

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