What is PRT?

Pain Reprocessing Therapy (PRT) was developed by Dr. Alan Gordon, a psychotherapist and founder of the Pain Psychology Center in Los Angeles. Gordon spent many years working with people suffering from chronic pain and observed that in many cases pain is not caused by ongoing bodily injury but by excessive reactivity and a false alarm in the brain.

Gordon based his work on the idea that pain may result from an overly alarmed nervous system rather than from tissue damage alone.

Publications and books: The Way Out is the first practical guide for patients, and Gordon’s earlier scientific papers with collaborators describe the therapy’s effectiveness and its neuroplastic mechanisms.

PRT emerged from pain neurobiology and research on neuroplasticity, the brain’s ability to change and to be reprogrammed.

Key scientific evidence:

• Clinical trial (Ashar et al., 2021, JAMA Psychiatry): in a randomized controlled trial involving 151 people with chronic back pain, a two-week PRT intervention produced significant pain reduction, and for some patients the pain disappeared completely.
• Brain imaging results showed that after PRT, activity decreases in brain regions associated with fear and threat (including the insula and anterior cingulate cortex), while activity increases in regions related to safety and control.
• The therapy combines elements of cognitive-behavioral psychology, exposure therapy, emotional processing and mindfulness.

PRT (Pain Reprocessing Therapy) is intended for people with chronic pain, especially pain that cannot be fully explained by changes seen in medical tests. It is useful for patients with nociplastic pain, pain maintained by an oversensitive nervous system. This includes, among others:

The therapy is intended for people whose pain intensifies under stress, fatigue or emotional strain, and for whom standard treatment such as medication, rehabilitation or physiotherapy brings little or only short-term relief. PRT helps reprogram the nervous system’s response, reduce fear of pain and rebuild a sense of safety in the body, so pain can gradually weaken and daily functioning can improve week by week.

• fibromyalgia,
• chronic spinal pain,
• migraine,
• neck pain,
• pelvic pain,
• IBS with a pain component,
• or pain with a shifting, migrating character.

Standard PRT therapy usually lasts 8 to 12 weeks, most often in the form of one session per week. This is only a general range; the total duration depends on several factors:

For some patients, the first clear effects appear after 4 to 6 weeks. Others need several months of steady work, especially if the pain has lasted for many years or is linked to strong fear conditioning.

After completing therapy, many people use maintenance sessions every 4 to 6 weeks or as needed in order to consolidate new patterns and prevent pain relapses.

• the complexity of symptoms, for example coexisting anxiety, trauma or longstanding pain,
• the patient’s commitment to exercises between sessions,
• the individual pace of neuroplastic change, which differs from person to person.

Functional pain, also called neuroplastic pain by psychologists and nociplastic pain by physicians, is a newer way of classifying chronic pain. Below are 10 of the most common components of neuroplastic pain used in PRT and in modern chronic pain approaches, based on PRT studies, O’Sullivan, Moseley, Schubiner and the nociplastic pain literature:

• Variability of symptoms: pain changes from day to day or throughout the day without a clear biological cause.
• No correlation with imaging or tissue damage: scans may show age-typical or neutral findings that do not match the intensity of pain.
• Pain dependent on stress or emotions: symptoms worsen under pressure, conflict, fear or mental overload.
• Improvement during relaxation or distraction: pain decreases during mental rest or absorbing activities.
• Presence of multiple different symptoms: migrating pain, changing locations, visceral symptoms or paresthesias without a single structural explanation.
• An exaggerated pain-fear response: ordinary bodily signals are interpreted as real danger.
• Sensitivity to touch, fatigue or minor effort: symptoms are disproportionate to the trigger, typical of central sensitization.
• History of trauma, chronic stress or difficult emotions: the brain becomes more reactive to signals from the body and environment.
• Sense of helplessness and catastrophizing: constant expectation of pain, dark scenarios and hypervigilance.
• Rapid response to pain education or PRT: even a change in the interpretation of symptoms often brings short-term relief, which is a strong sign of neuroplastic pain.
• In clinical practice, a simple criterion is used: 2 to 3 features are enough to consider neuroplastic pain as the main explanation, and 4 or more features make it highly probable. This criterion is consistent with the approaches of Schubiner, Lumley (PRT), O’Sullivan and ICD-11.
• Simplified clinical interpretation: 0 to 1 feature means insufficient evidence and a nociceptive or neuropathic mechanism probably dominates.
• 2 to 3 features: suspected functional or neuroplastic pain. This requires a deeper assessment of lifestyle, stress and emotional history.
• 4 to 6 features: predominantly neuroplastic pain; PRT and therapy focused on nervous system regulation have a strong chance of success.
• 7 or more: it is very likely that central sensitization plus fear-based reactions are the main mechanism. PRT, pain education, somatic tracking and down-regulation of threat systems are first-line treatment.