Pain Reprocessing Therapy (PRT) | How It Works

Last updated August 23, 2026 · 15 min read

By Tauri Urbanik, research writer and PainApp founder

A different treatment model

If you've had chronic pain for months or years, you've probably tried a lot. Physical therapy. Medications. Maybe injections. Maybe surgery. And if you're reading this page, those things probably didn't work. Or they worked for a while and then stopped.

Persistent pain can have nociceptive, neuropathic, nociplastic, or mixed contributors. PRT was designed for cases in which a clinician concludes that learned threat responses and central pain processing are important contributors.

Not "it's all in your head." Not imaginary. Not exaggerated. Your pain is real. Completely, undeniably real. But the source of that pain signal may be learned neural pathways in your brain rather than damage in your tissues.

Pain Reprocessing Therapy was built on this science. And it has the clinical trial results to back it up.

What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy is a treatment approach developed by Alan Gordon, a psychotherapist and founder of the Pain Psychology Center in Los Angeles. PRT teaches your brain to reinterpret chronic pain signals as non-dangerous. Instead of treating pain as evidence that something is broken in your body, PRT helps you experience it as what it often is: a false alarm from a nervous system stuck on high alert.

That sounds simple. And honestly, the concept is. But the science behind it is anything but.

Your brain produces every pain experience you've ever had. When you touch a hot stove, it's not your hand that "feels" pain. Your hand sends a signal. Your brain decides that signal is dangerous and creates the experience of burning. Pain is always a brain event.

In chronic pain, something goes wrong with this process. An original injury heals. The tissues repair. But the brain keeps generating pain signals as if the threat is still there. It's learned a pattern and it won't stop running it. Researchers call this central sensitization (Woolf, Pain, 2011↗). Your nervous system has become hypersensitive, cranking up the volume on normal body signals until they register as pain.

PRT directly targets this stuck pattern. It teaches your brain, through specific techniques, that the danger signals are false alarms. And when the brain gets that message, it starts turning the volume down.

The Boulder study that changed everything

In 2021, researchers at the University of Colorado Boulder published the first randomized controlled trial of Pain Reprocessing Therapy in JAMA Psychiatry, one of the most respected medical journals in the world (Ashar et al., JAMA Psychiatry, 2022↗).

Here's what they did. They took 151 people with chronic back pain. People who'd been hurting for years. People who'd tried other treatments. And they randomly assigned them to one of three groups: Pain Reprocessing Therapy, a placebo injection, or usual care.

The PRT group received 4 weeks of treatment. That's it. Eight sessions over one month.

The results?

That result applies to 33 participants in the selected, therapist-led PRT group—not to two-thirds of everyone with chronic back pain or to people using a self-guided app.

The PRT group improved more than both comparison groups at the primary endpoint. Because this was one trial in a selected back-pain population, replication and evidence in other conditions remain important.

The original paper reported benefits at one year, and a later follow-up reported group differences at five years. The comparison is encouraging, but it does not establish that PRT is superior to every medication, injection, rehabilitation program, or multidisciplinary treatment.

Brain imaging from the study showed something remarkable too. After PRT, activity in the brain's pain-processing regions actually decreased. The treatment wasn't just changing how people thought about pain. It was changing how their brains processed pain signals at a neural level.

How PRT actually works: the three core techniques

PRT isn't one thing. It's a system built on three interconnected techniques. Each one targets a different piece of the pain-learning cycle.

1. Somatic tracking

This is the foundation of PRT. And it's probably not what you'd expect.

Somatic tracking means paying attention to your pain with an attitude of curiosity and safety, rather than fear and bracing. When you feel pain, your natural response is to tense up, worry, and try to make it stop. That fear response tells your brain: this is dangerous. And the brain responds by amplifying the pain signal.

Somatic tracking reverses that. You attend to the sensation, but you do it calmly. Openly. With genuine curiosity about what you're actually feeling, separate from the fear around it.

When people observe a pain sensation with less fear, they may notice that its intensity, location, or quality changes. That can demonstrate real-time nervous-system modulation, but it does not diagnose the pain mechanism or rule out tissue and nerve contributors.

2. Safety reappraisal

Your brain is producing pain because it believes you're in danger. Safety reappraisal means giving your brain corrective information. Showing it, through evidence and experience, that the danger signal is wrong.

This looks different for everyone. It might mean reviewing your MRI results and understanding that the disc bulge your doctor pointed to appears in 50% of pain-free 40-year-olds (Brinjikji et al., AJNR, 2015↗). It might mean noticing that your pain gets worse with stress and better on vacation, which doesn't make sense for a structural problem but makes perfect sense for brain-generated pain. It might mean recognizing that your pain started during a divorce, not after an injury.

After appropriate clinical assessment, evidence that a movement or sensation is safe can help the nervous system update its assessment of danger. Safety reappraisal should not be used to dismiss new, worsening, or unexplained symptoms.

3. Corrective experiences

This is where the real unlearning happens. Corrective experiences are moments when you do something your brain expects will hurt, and it doesn't. Or it hurts less than expected. Or you respond to it differently.

Maybe you bend forward, something that always triggers pain, and you do it while practicing somatic tracking. You stay curious. You don't brace. And the pain is less. Or different. That single moment teaches your brain something powerful: this movement isn't dangerous.

Each corrective experience weakens the learned pain pathway. Over time, with enough repetitions, the pathway starts to go quiet. Your brain unlearns the pattern it spent months or years reinforcing.

Neuroscientists describe this as "neurons that fire together wire together, and neurons that stop firing together gradually unwire." Every time you respond to pain with fear, you reinforce the pathway. Every time you respond with curiosity and safety, you weaken it.

What a PRT session actually looks like

If you've never done brain-based pain therapy, you might be wondering what actually happens in a session. It's not what most people imagine.

You're not lying on a couch talking about your childhood. You're not doing positive affirmations or trying to "think away" the pain. PRT is much more specific than that.

A typical session might go something like this. Your therapist asks you to notice where your pain is right now. Not to fight it. Not to fix it. Just to notice. They might ask: what does it actually feel like? Is it sharp or dull? Does it have edges? Is it constant or does it pulse?

Then they'll guide you into somatic tracking. You attend to the sensation while your therapist helps you maintain a sense of safety. They might remind you that the pain is a false alarm. That your body is healthy. That what you're feeling is real but not dangerous.

During this process, the pain may decrease, move, or change quality. A therapist may use that change to illustrate that attention and perceived safety can modulate pain in real time. A shift is not proof that there is no tissue damage.

Between sessions, you practice on your own. You bring somatic tracking into your daily life. When pain flares, instead of panicking or bracing, you observe. You remind yourself of the evidence. You build corrective experiences by doing activities you've been avoiding, carefully and with curiosity rather than fear.

The Boulder trial used 8 sessions over 4 weeks. Some practitioners use more. Some people need less. The timeline varies. But the approach is consistent: interrupt the fear-pain cycle, show the brain there's no danger, and let the learned pain pathways weaken over time.

Try somatic tracking right now

You don't have to take anyone's word for this. You can experience a version of somatic tracking right now, in 5 minutes. The exercise below walks you through it step by step.

Pay attention to what happens without using the exercise as a diagnostic test. Pain from many causes can fluctuate with attention, movement, stress, or context.

Any change shows that the nervous system can modulate the experience in real time. It is a useful observation to discuss with a qualified clinician, not proof that your pain is exclusively neuroplastic.

Who is PRT for?

Pain Reprocessing Therapy was designed for neuroplastic pain. That's pain generated by learned brain pathways rather than ongoing structural damage. But how do you know if that's you?

Research by Apkarian and colleagues found that brain connectivity patterns, not the severity of the original injury, predict who develops chronic pain (Apkarian et al., Journal of Neuroscience, 2004↗). Two people with identical injuries. One recovers. One develops chronic pain. The difference isn't in their bodies. It's in their brains.

Certain patterns strongly suggest neuroplastic pain. See how many you recognize.

If several resonate, it may be worth discussing nociplastic or learned-threat contributors with a qualified clinician. These patterns are not diagnostic on their own.

But let's address the concerns you're probably thinking right now.

"This sounds too simple"

Fair point. The concept of PRT is simple enough: teach your brain the danger signal is false. But the science behind it is anything but simple. Thousands of peer-reviewed studies on central sensitization, brain imaging, neuroplasticity, and pain processing support this approach. The application is accessible. The research base is vast.

Think of it this way. The concept of antibiotics is simple too. Bacteria cause infection, medicine kills bacteria. But the biochemistry behind it fills entire textbooks. PRT works the same way. Simple to understand. Backed by deep science.

"My doctor said it's structural"

Your doctor saw real findings. Disc bulges. Degeneration. Arthritis. Those findings are real. But a systematic review of over 3,000 pain-free people found that those same findings are shockingly common in people who feel perfectly fine (Brinjikji et al., AJNR, 2015↗). At age 40, half of pain-free people have disc bulges. At 80, 96% have disc degeneration. No pain.

Your doctor was trained to connect structural findings to pain. Most were. The neuroscience is just ahead of what's being taught in most medical schools right now. That doesn't mean your doctor is wrong about what they see. It means what they see may not be causing your pain.

PRT compared to other treatments

How does Pain Reprocessing Therapy stack up against conventional approaches? The comparison is striking.

The conventional approaches share a common limitation. They treat the body. And if the pain is being generated by the brain, targeting the body will produce limited, temporary results at best. PRT goes directly to the source.

D

David, 47

chronic back pain for 8 years

David had tried everything for his back pain. Physical therapy three different times. Epidural injections. Facet joint blocks. Two different pain medications. His surgeon recommended a fusion. His MRI showed two disc bulges, and everyone agreed that was the problem. But David's wife noticed something his doctors never asked about. His pain always got worse before his quarterly work reviews. It eased up on camping trips. And it had started the month after his father died. He tried PRT with some skepticism. Within the first session, during somatic tracking, his pain dropped from a 7 to a 4. He thought it was a fluke. But over 4 weeks, the pattern held. He's not completely pain-free. He still gets flares during stressful weeks. But he went from considering spine surgery to managing occasional discomfort. No medication. No procedure. Just a different relationship with the pain signal.

Composite story based on common patient patterns. Not a specific individual.

How to access Pain Reprocessing Therapy

If you're wondering where to find pain reprocessing therapy near you, there are several options. Our PRT practitioner guide explains how to compare roles, verify licensure, and confirm whether online care is permitted where you are located.

In-person PRT therapists

The Pain Psychology Center in Los Angeles, founded by Alan Gordon, trains therapists in PRT. A growing number of practitioners across the U.S. and internationally now offer PRT-informed treatment. Many also offer telehealth sessions, so location doesn't have to be a barrier.

When searching for a therapist, look for someone trained specifically in PRT or who has completed the Pain Reprocessing Therapy certification. General therapists or pain psychologists may use related techniques but won't necessarily follow the specific PRT protocol tested in the Boulder trial.

App-based PRT programs

Not everyone has access to a PRT-trained therapist. And even if you do, cost can be a barrier. App-based programs that guide you through PRT techniques, including somatic tracking and safety reappraisal, have emerged as an accessible alternative.

These programs walk you through the same core principles at your own pace. They're not identical to working with a skilled therapist, but they put the fundamental tools in your hands at a fraction of the cost.

Pain Neuroscience Education as a starting point

Pain Neuroscience Education can help people understand sensitization and participate in care. A 2016 systematic review reported improvements across several outcomes, but newer umbrella evidence is more cautious: PNE appears more useful alongside multimodal care than as a standalone treatment (Louw et al., Physiotherapy Theory and Practice, 2016↗). Reading about pain may support treatment; it is not equivalent to the multi-component PRT protocol tested in the trial.

The brain can unlearn pain

Here's what it all comes down to. Your brain learned a pain pattern. Through neuroplasticity, the same mechanism that created that pattern, it can unlearn it. Neural pathways that get reinforced grow stronger. Neural pathways that stop getting reinforced weaken and go quiet.

PRT works with this process, not against it. By interrupting the fear-pain cycle, providing the brain with evidence of safety, and creating corrective experiences where expected pain doesn't materialize, PRT helps those overactive pain pathways fade.

Is it guaranteed? No. Does everyone become pain-free? No. In the Boulder study, 33 of 50 people assigned to PRT were pain-free or nearly pain-free after treatment; 17 did not reach that threshold. Being precise about the denominator and population matters.

But even the participants who didn't become pain-free showed improvement. And the ones who did stay better at five years. That durability alone sets PRT apart from most pain treatments, which require ongoing maintenance.

If you've been living with chronic pain and current care has not helped enough, PRT may be one option to discuss with your care team when pain-processing mechanisms are relevant. It can complement, rather than automatically replace, medical and physical care.

Frequently asked questions

What is Pain Reprocessing Therapy?

Pain Reprocessing Therapy (PRT) is a psychological treatment designed to help people reappraise pain signals assessed as non-dangerous. In a JAMA Psychiatry trial, 33 of 50 participants assigned to PRT for primary chronic back pain were pain-free or nearly pain-free after treatment.

How long does Pain Reprocessing Therapy take?

The randomized trial used eight therapist-led sessions over 4 weeks. Treatment length and response vary, and the trial protocol should not be treated as a promised timeline for an individual.

Does Pain Reprocessing Therapy work for all types of pain?

No. The strongest randomized evidence is for selected adults with primary chronic back pain. PRT has not been established for every pain condition, and a qualified clinician should assess tissue, nerve, disease-related, and mixed contributors.

How do I find a Pain Reprocessing Therapy therapist?

Look for a licensed mental-health professional with specific pain-treatment training, and verify their credentials and scope of practice. Self-guided apps may teach related skills, but they are not equivalent to the therapist-led protocol tested in the trial.

Is Pain Reprocessing Therapy covered by insurance?

Coverage varies by clinician, plan, and location. Ask the provider which service and billing code they use, then confirm benefits and out-of-pocket costs with your insurer.

References

1. Ashar YK, 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. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15.DOI: 10.1016/j.pain.2010.09.030
3. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.DOI: 10.3174/ajnr.A4173
4. Apkarian AV, et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience. 2004;24(46):10410-10415.DOI: 10.1523/JNEUROSCI.3623-04.2004
5. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 2016;32(5):332-355.DOI: 10.1080/09593985.2016.1194646
6. Ashar YK, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025.DOI: 10.1001/jamapsychiatry.2025.1844