Pain reprocessing therapy

Domain II · Behavioural & cognitive · Alan Gordon · Los Angeles

What it is

Pain Reprocessing Therapy (PRT) is a brief psychological treatment for chronic "primary" or "neuroplastic" pain. This is pain that persists without ongoing tissue damage and is maintained by central nervous system processes, e.g. most chronic back pain, tension headache, and some neck, pelvic and…

Format

• Format. PRT is delivered as individual sessions, in person or by video, or as a structured group. The self-help version is the book.
• Trial dose: one telehealth medical evaluation with a physician, then 8 PRT sessions over 4 weeks (about twice weekly).

Evidence status, as the guide reports it

• Begin with education, evidence gathering and safety reappraisal of the pain, usually through somatic tracking.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• forced positivity. The aim is ease, not denial.
• arguing. Use curiosity and collect more evidence instead of debating.
• the patient scanning for pain while doing it. Bring them back to ease.
• the patient catching themselves in "forcing it". That is a good sign of mastery.
• reading used to hunt for reassurance about the pain. Gently redirect to practice.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.