Pain Reprocessing Therapy (PRT) in NYC: A New Approach to Chronic Pain
Updated: Sep 17
What PRT is, what we're learning about neuroplastic pain, and how that understanding informs my acupuncture practice on the Upper West Side.
If you've had pain for months or years—especially pain that has persisted despite physical therapy, medication, injections or other treatment—you may have heard terms like central sensitization, neuroplastic pain or Pain Reprocessing Therapy (PRT).
The basic idea is fascinating: pain is not simply a readout of what's happening in the tissues.
Pain is a protective response produced by the nervous system. Sometimes it corresponds very closely to an injury or other structural problem. But in some people with persistent pain, the nervous system can become increasingly sensitized and protective, so the intensity or persistence of the pain is no longer adequately explained by ongoing tissue damage alone.
That doesn't mean the pain isn't real.
The pain is real. The question is what is continuing to produce it.
What is Pain Reprocessing Therapy?
Pain Reprocessing Therapy is an evidence-based psychological treatment developed by Alan Gordon, LCSW and informed by the work of physicians and researchers studying persistent pain.
PRT helps appropriately selected patients reinterpret pain sensations that are safe as less threatening. It uses techniques including education, safety reappraisal, somatic tracking and exposure to help reduce the fear and danger response that can reinforce some forms of persistent pain.
One of the best-known studies of PRT is the Boulder Back Pain Study.
Researchers randomized 151 adults with chronic back pain to PRT, an open-label placebo treatment or usual care. After treatment, 66% of the participants receiving PRT were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% receiving usual care. Improvements in the PRT group were substantially maintained at the one-year follow-up.
That's an extraordinary result—but an important bit of context often gets lost when the study is discussed.
The participants had chronic back pain that researchers considered likely to be primarily generated or maintained by central nervous-system processes rather than an identifiable ongoing peripheral cause. Their pain was generally of low-to-moderate severity.
So the study does not mean that 66% of everyone with chronic pain can eliminate it with PRT.
It tells us something much more useful: for appropriately selected people, changing the brain's interpretation of pain can significantly change the experience of pain itself.
Who might have a neuroplastic component to their pain?
There isn't one simple test.
Some patterns can make me more curious about a nervous-system contribution: pain that persists long after an injury should have healed, symptoms that move or vary substantially, pain that changes dramatically depending on context, or symptoms whose intensity isn't well explained by the available structural findings.
But none of those things proves that pain is neuroplastic.
And not every chronic pain problem is.
A disc can irritate a nerve. Arthritis can hurt. Tendons can be injured. Muscles can function poorly. Some symptoms require medical evaluation or structural treatment.
That's why the question isn't:
“Is the pain in the body or in the brain?”
The brain is part of the body, and pain can involve structure, muscle function, nervous-system processing—or several of those at once.
The better question is:
“What appears to be contributing to this person's pain?”
How I use PRT in my acupuncture practice
This is an important distinction.
I'm an acupuncturist, not a psychotherapist, and I don't offer psychotherapy sessions.
I completed certification in Pain Reprocessing Therapy because understanding neuroplastic pain changed the way I assess persistent symptoms and the way I talk to my patients about pain.
Want to know more about how this fits into my acupuncture treatments? [Learn how I use Pain Reprocessing Therapy in my practice →]
When someone's history suggests that nervous-system sensitization may be part of the picture, I explain what that means. I may introduce concepts I've learned through PRT training, including somatic tracking and safety reappraisal, and help patients understand why a sensation doesn't necessarily mean that they're damaging themselves.
That understanding can also change the context in which I provide acupuncture.
If I'm working on muscles, movement or pain while you're terrified that every sensation means your body is being injured, we're missing an important part of the picture.
Sometimes reducing the fear surrounding a sensation is part of helping the nervous system become less protective.
For patients who want to explore these ideas further, I frequently recommend Alan Gordon and Alon Ziv's book The Way Out. And when someone would benefit from more extensive therapeutic work, I refer to therapists who work more deeply in this area.
Where does acupuncture fit?
Acupuncture and PRT are different interventions, and I don't think we need to pretend they're doing exactly the same thing.
Acupuncture can be useful in the treatment of chronic pain. PRT gives us another framework for understanding why pain sometimes persists and how beliefs about danger, fear and attention can influence the pain experience.
In my practice, those perspectives can complement one another.
I may use traditional acupuncture, motor point acupuncture or electroacupuncture to address pain and muscle function while also using what I've learned from PRT to help a patient make sense of a nervous system that has become overly protective.
The needles are one tool. Understanding what's happening is another.
Pain isn't “all in your head”
This is worth saying again.
Recognizing a neuroplastic component to pain doesn't mean telling someone that nothing is wrong or that they're imagining their symptoms.
Pain is produced by the nervous system whether you step on a nail, irritate a nerve or experience persistent pain after an injury has healed.
Understanding that gives us more ways to approach pain, not fewer.
And sometimes the most important thing I can give a patient is permission to stop treating every sensation as evidence that their body is breaking.
Want to learn more?
If you're curious about the strange relationship between the brain, danger and pain, I wrote an earlier piece called Pain and the Brain, including two remarkable stories that first helped draw me into this work.
For a deeper dive, I recommend The Way Out by Alan Gordon and Alon Ziv.
And you can read the original Boulder Back Pain Study here:
Could neuroplasticity be part of your pain?
You don't need to diagnose that yourself before making an appointment.
If you're dealing with persistent pain that hasn't responded as expected—or pain that simply doesn't make sense—we can look at the whole picture: your medical history, structural findings, muscle function, how the symptoms behave and whether nervous-system sensitization may be contributing.
AB Acupuncture is located inside W72 Wellness at 118 West 72nd Street, between Columbus Avenue and Broadway, on Manhattan's Upper West Side..
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