Pain reprocessing therapy has been getting a bit more attention lately, particularly in the world of chronic pain. For people whose symptoms don’t quite match their scan results or who’ve tried traditional treatments without much change, it’s an approach that often sparks curiosity.
There’s a lot of information (and opinion) out there, so this article is about cutting through the noise. We’ll walk through what PRT actually is, what the evidence tells us, and when it may or may not be worth considering as part of a broader recovery plan.
What is pain reprocessing therapy (PRT)?
Pain reprocessing therapy (PRT) is a specific form of pain education combined with nervous system retraining exercises designed to help people with chronic pain retrain the way their brain interprets pain signals. Rather than focusing on the body alone, PRT works with the nervous system (particularly in cases where pain continues despite no clear tissue damage).
The idea is that the brain can sometimes get “stuck” in protection mode, continuing to send pain signals even after an injury has healed. This is known as neuroplastic pain, and it’s more common than many people realise.
PRT helps people understand that these pain signals, while very real, are often the result of a sensitised system rather than ongoing harm. Through techniques such as somatic tracking, mindfulness, and cognitive reframing, the goal is to reduce fear around pain, calm the nervous system, and change the brain’s response over time.
Does it work? What the research shows
When it comes to the evidence, PRT has some of the most compelling data we’ve seen for a non‑pharmacological approach to certain types of chronic pain.
A landmark randomised clinical trial published in JAMA Psychiatry tested PRT against both usual care and an open‑label placebo in people with chronic back pain for which no clear physical cause could be found. In that study, 66% of people receiving PRT were pain‑free or nearly pain‑free at the end of treatment, compared with just 20 percent in the placebo group and 10 percent with usual care. Importantly, these results were largely maintained at one-year follow-up, suggesting a durable effect beyond the immediate treatment period.¹ᵃ
The same trial also included functional brain imaging, which showed reduced pain‑related activity in brain networks associated with threat processing after PRT. This supports the idea that PRT doesn’t “just” teach coping techniques, but may actually help change how the nervous system processes pain signals.¹ᵇ
Findings like these align with a growing body of pain science suggesting that addressing fear, threat perception, and unhelpful pain beliefs can play a meaningful role in recovery for some people with chronic pain. Rather than focusing solely on managing symptoms, brain-directed approaches such as PRT aim to change the underlying pain processing mechanisms that keep the nervous system sensitised.
How to know if PRT is right for you?
Who might be a good fit for PRT
- Have chronic musculoskeletal pain with no clear structural cause
- Experience pain that comes and goes without a consistent pattern
- Have already tried traditional treatments (e.g. physio, medication) with limited improvement
- Notice symptoms are linked to stress, movement, or certain thoughts
- Have been told their scans are “normal”, but still feel significant pain
- Are open to understanding how the brain and nervous system influence pain
When PRT might not be the right approach
- There’s an acute injury or structural issue that needs medical or surgical care
- You’re in the early recovery phase following recent surgery
- There are red flags indicating serious underlying conditions (e.g. infection, fracture)
- You’re looking primarily for manual therapy or physical treatments
- Exploring the brain’s role in pain doesn’t feel like the right fit for you at this time
The limits of PRT (and why that’s not a bad thing)
Like any therapy, PRT isn’t a quick fix or a guaranteed solution. It’s one part of a broader recovery process that involves understanding your pain, changing how your nervous system responds, and gradually rebuilding trust in your body.
The pain is still real, even when it’s being driven by the brain rather than an injury. That doesn’t mean it’s imaginary, and it’s not something you can just “think away.” What it does mean is that with the right support and the right approach, it’s possible to shift how your brain processes those signals over time.
That’s why personalised care makes a difference. PRT tends to be most effective when combined with movement support, pain education, and strategies that are shaped around your individual story.
How PRT fits into a broader pain management plan
For many people, the best results come when PRT is used as part of a broader pain recovery plan that supports the nervous system and rebuilds confidence in movement.
At Integrity Physiotherapy, PRT can be integrated into a wider plan that includes movement retraining, somatic tracking, pain neuroscience education, and ongoing support. The focus is on helping you understand your pain, reduce fear, and rebuild confidence in movement—step by step.
A different way forward
If your pain has lingered despite clear scans or traditional physio, it might be time to look at what your nervous system is doing and why.
At Integrity Physiotherapy, our approach to persistent pain is built around modern pain science and a thorough understanding of how the nervous system contributes to ongoing symptoms. We take the time to assess your presentation, screen for red flags, and tailor strategies that may include pain education, brain-based retraining approaches such as PRT, somatic tracking, and movement-based recovery. We provide a range of physical and brain-based exercises, delivered digitally, to help you navigate your recovery.
If you’re ready to try a more tailored, brain-informed approach to pain, we’re here to help you take that next step.
Referenced Articles
¹ᵃ
Ashar, Yoni K., Abigail S. Gordon, Howard Schubiner, Mark A. Uipi, Devon H. Knight, Tor D. Wager, and A. Vania Apkarian. 2021. “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.” JAMA Psychiatry 79 (1): 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669.
¹ᵇ
National Institutes of Health. 2021. “Retraining the Brain to Treat Chronic Pain.” NIH Research Matters, November 2, 2021. https://www.nih.gov/news-events/nih-research-matters/retraining-brain-treat-chronic-pain.
Suffering from chronic pain? The team at Integrity can help.
