What is Pain Reprocessing Therapy?
By Danni Bichler
Pain Reprocessing Therapy (PRT) is a collection of psychological techniques drawn from pain neuroscience education, cognitive-behavioral therapy (CBT), and mindfulness-based stress reduction. These techniques are designed to rewire the brain and break the cycle of chronic pain.
To understand the PRT approach you need to understand the pain science behind it. Chronic pain behaves very differently to acute pain. Firstly all pain is a danger signal that is designed to keep us safe from perceived threats. For example when you put your hand on a hot stove the pain is a warning signal that the surface is hot and sends a signal to quickly remove your hand to avoid being burnt. Acute pain is caused by an injury or tissue damage and it resolves as the tissue heals. Chronic pain on the other hand can persist long after the original tissue injury has healed or can start without having any injury at all!
This is because chronic pain occurs when the brain becomes hypersensitive and can begin to interpret normal, safe sensations as dangerous and painful. Put simply it is like a false alarm where the brain has turned up the volume on pain. There are many emotional and cognitive factors that can lead to this process happening but although pain can be learnt by the brain it is still very real pain. Ths important distinction between acute and chronic pain here is not only length of time of the pain but that in chronic pain there is no longer the external stimulus of injury, but instead has become a self-perpetuating cycle dependent on learned neural pathways and nervous system function.
PRT can be used to treat the following conditions:
Chronic Pelvic Pain
Vulvodynia
Low back pain
Migraines
Fibromyalgia
Interstitial Cystitis
Many other chronic pain syndromes
Does Pain Reprocessing Therapy work?
A study published in 2022 in the JAMA Psychiatry, a peer-reviewed medical journal published by the American Medical Association demonstrated the clinical efficacy of Pain Reprocessing Therapy.
Results of the study show:
66% of participants in the PRT group were pain-free or nearly pain-free at post-treatment (vs. 20% in the placebo group, 10% in the usual standard of care group)
Gains were largely maintained at a 1-year follow-up
MRI results showed noticeable changes in the brain's response to pain in the PRT group relative to the other groups
How you can get started today?
The first stage of PRT is learning about chronic pain neuroscience. This means learning about what is actually happening in the brain and nervous system when chronic pain occurs. This knowledge is foundational to the next steps of PRT. Here are some great resources to watch on the chronic pain cycle:
A number of PRT exercises focus on the reduction of fear around pain. As we know now pain is a danger signal and the opposite of danger is safety. An easy exercise we can start with to reduce fear around pain is called:
Sending Messages of Safety
Place your hand on your heart and take a few deep slow breaths. Slow down the speed of your thoughts by talking out loud to yourself. Some examples of safety messages include: “I am safe in this moment. I am sore but I am safe and this moment will pass. This sensation is just a signal coming from my brain. My brain is interpreting these signals incorrectly. This will pass and I know I am going to be ok.” Slow down breathing, relax your jaw, lower your shoulders. Revisit this as many times throughout the day as you need.
Vagus Nerve Stimulation
The vagus nerve is responsible for regulating your heart rate, inflammation, emotions, digestion, pain and anxiety levels. When the vagus nerve is stimulated you feel calmer, more regulated and clear headed. The nerve passes through the soft tissue in the back of the throat and when you make deep humming noises that cause vibrations through the face, neck and throat this helps to activate the vagus nerve. While in the shower or brushing your teeth hum, sing or gargle to stimulate the vagus nerve. Other ways to stimulate your vagus nerve - Cold water immersion (cold dip in the ocean with head under or cold shower), laughter (watching a funny show or movie) and deep slow belly breathing.
What now?
More and more research is showing us that some of the most powerful treatments for chronic pain are focused on the brain. If you are experiencing chronic pain and you haven’t noticed positive and long lasting results from physical treatment then Pain Reprocessing Therapy is for you!