Pain Reprocessing Therapy & Neuroplastic Pain
Sometimes pain continues after the danger has passed.
Pain is one of the body's most important protective systems.
If you injure yourself, you want your brain to sound the alarm. Pain changes your behavior so you protect the injured area while it heals.
But sometimes that alarm system becomes overly protective.
Pain can persist after an injury has healed. It can fluctuate in ways that don't correspond neatly to what's happening in the tissues. It may move, disappear and return, or become increasingly associated with movements and activities that the brain has learned to interpret as dangerous.
This is where an understanding of neuroplastic pain can become useful.
What is Pain Reprocessing Therapy?
Pain Reprocessing Therapy, or PRT, is an evidence-based approach developed by Alan Gordon, LCSW and informed by the work of physicians and researchers including Dr. Howard Schubiner.
PRT is based on our growing understanding that some persistent pain is maintained or amplified by the nervous system even when ongoing tissue damage doesn't adequately explain the symptoms.
The pain is real.
But if the nervous system has learned to produce or amplify a protective response, neuroplasticity means it may also be capable of learning something different.
One of the best-known studies of PRT is the Boulder Back Pain Study. In that randomized trial of 151 people with chronic back pain, 66% of participants receiving PRT were pain-free or nearly pain-free after treatment, compared with 20% receiving placebo treatment and 10% receiving usual care.
[Read the Boulder Back Pain Study →]
How I use PRT in an acupuncture practice
This distinction is important:
I am an acupuncturist, not a psychotherapist.
I completed certification in Pain Reprocessing Therapy because understanding neuroplastic pain changed the way I think about persistent symptoms—and it changed the way I talk to my patients.
I'm not conducting psychotherapy while you're on the acupuncture table.
Instead, PRT informs how I assess your pain and how we talk about what's happening.
If your history suggests that your nervous system may have become overly protective, I may help you understand why that happens, point out patterns that support a neuroplastic contribution, introduce concepts such as somatic tracking or safety reappraisal, and help you become less afraid of sensations that aren't signaling ongoing damage.
Sometimes simply understanding why something hurts begins to change the relationship you have with the pain.
For patients who want to explore the work more deeply, I often recommend Alan Gordon's book The Way Out. And when someone would benefit from more extensive therapeutic work, I can refer to clinicians who practice in that realm.
PRT is a lens and a set of tools that inform my acupuncture practice.
It isn't a replacement for psychotherapy—and acupuncture isn't psychotherapy with needles.
First we ask whether something actually needs protecting.
Not every pain problem is neuroplastic.
A disc can compress a nerve. A tendon can be injured. Arthritis can hurt. Muscles can function poorly. A fracture needs to heal. Some symptoms require medical evaluation or structural treatment.
That's why I don't start by telling someone, “Your pain is coming from your brain.”
I start by asking:
What could reasonably be contributing to this pain?
That may include imaging, your medical diagnosis, how the symptoms behave, movement and muscle function, previous injuries, what makes the pain better or worse, and how the symptoms have changed over time.
Sometimes the answer is primarily structural.
Sometimes it's muscular.
Sometimes nervous-system sensitization appears to be playing an important role.
And very often, more than one thing is true at the same time.
Why combine this understanding with acupuncture?
This is where PRT has become particularly useful in my practice.
I may be using acupuncture or motor point techniques to work with pain and muscle function while also helping you understand why the nervous system may still be protecting an area.
Instead of treating your body while leaving you frightened of every sensation it produces, we can work from both directions.
The needles are one part of treatment.
What your brain believes is happening in your body can be another.
Want to understand more?
If this idea is new to you, I recommend starting with one of these:
[Read: Pain Reprocessing Therapy in NYC — A New Approach to Chronic Pain →]
This is my newer explanation of PRT, neuroplastic pain and the research behind it.
[Read: Pain and the Brain →]
This older piece tells the story of how I first became interested in PRT—and includes two of my favorite examples of just how strange and fascinating the brain's pain system can be.
And if you want to go deeper, I recommend Alan Gordon and Alon Ziv's book, The Way Out.
Could neuroplasticity be part of your pain?
You don't have to figure that out before you come in.
If you're dealing with persistent pain—particularly pain that has continued despite treatment or doesn't behave quite the way you'd expect—we can look at the whole picture and decide what makes sense.
Book an Appointment or Free 15-Minute Consultation:
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AB Acupuncture is located inside W72 Wellness at 118 West 72nd Street, between Columbus Avenue and Broadway, on Manhattan's Upper West Side.