Pain Reprocessing Therapy at KIHC
This ground-breaking Pain Reprocessing Therapy (PRT) was developed by Psychotherapist Alan Gordon, in partnership with many colleagues, including Dr. Howard Schubiner and Dr. Yoni Ashar. Some people consider it as a a progression of 3 decades of work by Dr. John Sarno. Peer-reviewed and published results from PRT clinical trials are the first I’m aware of to show resolution of some types of chronic pain in just 4 weeks. This has understandably caught many people’s attention, and I’m excited to bring these principles to Kingston Integrated Healthcare, as part of an individualized and holistic program.
The Danger Threshold
The brain processes all pain. It receives “danger” signals from our body and it responds until the danger has passed. But what if the danger doesn’t pass for a long time? What if the brain continues to perceive a threat long past when the original injury healed? Can the brain get stuck in this learned pattern of experience?
Pain Reprocessing Therapy theory says yes: the brain can and does get stuck in learned patterns of generating pain. We call this nociplastic or neuroplastic pain, and these therapies are about unlearning these patterns. It requires that we make the brain feel as safe as possible by identifying and treating those danger signals.
The Danger Signals
Physical injuries heal. And many of the physical changes that occur in our bodies as we age do not inherently cause pain. (Look at this research paper on expected spinal degeneration in asymptomatic people.) This is a critical point to acknowledge: Though we might find evidence of wear and tear in our physical bodies, this isn’t always the cause of the pain. And if you’ve been treating this structural problem for months or years and are getting no where, then please keep reading.
Everything in the body is connected. Many people experienced in the approaches of integrative or holistic medicines understand that the-problem-to-treat is rarely where we feel the pain. This is why Naturopathic Doctors, Traditional Chinese Medicine practitioners, Ayurvedic practitioners, and Osteopathic Manual Therapists frequently work on entirely different systems or locations than what you might have expected.
Mind and body are also connected. This is an often-overlooked and misunderstood source of danger signal. Emotions and thoughts aren’t just fleeting experiences created by the mind. They have a significant impact on how and even when the brain registers a danger signal. Explore this interesting research in which Tylenol appears to blunt the pain of social rejection, and here, where emotional pain registers in the same brain regions as physical pain.
Your Body Isn’t Broken (So Stop Trying to Fix It)
Do you believe that your body can heal? Many people with chronic pain are told to accept that their pain will never resolve and to manage it indefinitely. I find this to be one of the biggest obstacles most people face after years of navigating an imperfect healthcare system and a serious chronic health condition. The body heals – not always the way we want or expect – but it does heal.
If we truly embrace human beings as a part of nature and its “laws” (rather than as a machine with broken parts), it’s easier to accept that your symptoms are a reflection of your body still working hard for you, protecting you, and not broken. If we tune into the research that says that the neck, back, or joint pain might not be because of the degeneration there, then it’s easier to believe that the brain can heal this. The brain is one healing mechanism that many people with chronic pain have yet to tap into.
Next Steps in Pain Reprocessing Therapy
The next steps in Pain Reprocessing Therapy involve tapping into the brain’s healing potential by solely addressing thoughts and emotions that contribute to those danger signals. You want to teach the brain that these danger signals are harmless and insignificant. For some people, this approach alone can resolve chronic pain.
My philosophy is slightly different from PRT, in that I believe that those physical danger signals are significant. They’re evidence of genuine physical imbalances – even if bloodwork and MRIs or CT scans are normal. It’s important to acknowledge these danger signals as messages from your body and not dismiss them as dysfunctional or misguided signals (i.e. “broken”). It’s the acknowledgement and integration of the danger signal that diffuses the intensity of the danger, making it easier for the brain to increase healing through neuroplasticity.
Getting Started
My job is to help you explore whether your pain is predominantly nociplastic and likely to respond to neuroplastic techniques. We’ll create a plan that matches your experience of pain. If you’d like to try Pain Reprocessing Therapy, I’m happy to refer you to our newest recruit to KIHC: Dr. Mike Tung ND. Dr. Mike is certified in PRT and offers telemedicine (online) appointments for KIHC patients.
One final point: This approach is versatile and possibly well suited to other chronic health concerns like long-COVID, chronic Lyme Disease, Fibromyalgia/ME, and migraine. The research suggests that resolution of these conditions is possible using this approach, and I’ve enjoyed good success applying Pain Reprocessing strategies in these situations for my patients.
Resources for Pain Reprocessing Therapy:
The Pain Reprocessing Therapy Workbook, Vanessa Blackstone, Nov 2024, and Emotional Awareness Expression Therapy (EAET) resources (a common adjunctive treatment to PRT) at the Society for Health Psychology.
Alan Gordon’s book The Way Out, and website.
Reign of Pain by Dr. Howard Schubiner, Michigan State University, free course on Coursera. Podcasts and online resources about PRT with Dr. Howard Schubiner.
Other brain re-training programs:
These include the Lightening Process, Gupta Program, and work by Veronique Mead and Eleanor Stein. All of these align with a holistic approach.
References:
Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry. 2021;79(1):13-23. doi:https://doi.org/10.1001/jamapsychiatry.2021.2669
Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain. JAMA network open. 2023;6(9):e2333846-e2333846. doi:https://doi.org/10.1001/jamanetworkopen.2023.33846
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015;36(4):811-816. doi:https://doi.org/10.3174/ajnr.a4173
Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. 2010;21(7):931-937. doi:https://doi.org/10.1177/0956797610374741
Donnino M, Howard P, Mehta S, et al. Psychophysiologic Symptom Relief Therapy for Post-Acute Sequelae of Coronavirus Disease 2019. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2023;7(4):337-348. doi:https://doi.org/10.1016/j.mayocpiqo.2023.05.002
Ebrahim Norouzi, Mehran Pournazari, Toraj Ahmadi Joybari, et al. Two non-pharmacological interventions, amygdala and insula retraining (AIR) and physical activity, are both significantly more effective than standard medication in improving symptoms of fibromyalgia. Current Psychology. Published online April 15, 2025. doi:https://doi.org/10.1007/s12144-025-07808-w
Kross E, Berman MG, Mischel W, Smith EE, Wager TD. Social Rejection Shares Somatosensory Representations with Physical Pain. Proceedings of the National Academy of Sciences. 2011;108(15):6270-6275. doi:https://doi.org/10.1073/pnas.1102693108
Tankha H, Lumley MA, Gordon A, et al. “I don’t have chronic back pain anymore”: Patient experiences in Pain Reprocessing Therapy for chronic back pain. The Journal of Pain. 2023;24(9). doi:https://doi.org/10.1016/j.jpain.2023.04.006
*Image from Freepik.
