Over 25 million people in the United States live with some form of pain that has lasted for more than three months. Existing and common treatments for chronic pain fail to provide relief for many of these individuals.

Pain reprocessing therapy is a new type of therapy that combines mindfulness and other mental health therapies with traditional physical therapy exercises to reduce or even eliminate chronic pain.

Pain Reprocessing Therapy Background

Pain reprocessing therapy (PRT) originates from the concept that there are several chronic pain mechanisms:

  • Neuropathic pain is the result of damage or disease affecting the nervous system
  • Nociceptive pain is the typical sensation of pain with a clear stimulus
  • Nociplastic pain has no clear cause or injury
  • Psychogenic pain comes from or is worsened by mental or behavioral factors

The theory behind pain reprocessing therapy is that many conditions are actually nociplastic or psychogenic, meaning that it may be possible to retrain the brain to either stop creating pain or better manage pain signals from the body.

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The Theory of PRT

Some conditions, such as chronic back pain or fibromyalgia, are potentially nociplastic or psychogenic because they have no visible physical cause. Experts believe that the pain is the result of brain changes that persist long after an injury has healed.

Following an injury, these changes likely warned the body to restrict movement so as to improve recovery. After recovery, however, the brain may continue to send pain signals, resulting in chronic pain. Therapists help patients perform painful movements while re-evaluating the cause or intensity of the sensations.

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Components of PRT

At its core, PRT has five components.

  1. The first is to educate participants about the origins of pain, the pain-fear cycle, and how pain is reversible.
  2. Second, therapists will help patients understand that their pain is not the result of a physical issue, but a central process. For example, many people experience pain when feeling high levels of stress, even without an injury.
  3. Therapists then help guide participants through various exercises to change how they view pain.
  4. During this stage, they may also address emotional, behavioral, or other mental triggers of pain sensations.
  5. The ultimate goal is to reduce overall pain levels by encouraging positive mentalities and sensations.

Shot of a young physiotherapist assisting a senior patient in recovery Dean Mitchell / Getty Images


Who Benefits from PRT

Because PRT is still a relatively new therapy, experts are not yet fully confident in what conditions it can treat. Currently, study results indicate that PRT may help with conditions like fibromyalgia, chronic back pain, and irritable bowel syndrome.

Beyond these issues, experts think it may help anyone with nonspecific pain or pain that does not respond to other intervention options.

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Potential Benefits

One of the highest-quality studies investigated the effects of PRT on people with chronic back pain without a physical cause. After four weeks of treatment with PRT, 98% of study participants showed some level of improvement.

Around two-thirds of patients were pain-free or nearly pain-free after the study. After a year, researchers returned to the study and confirmed that all outcomes had remained.

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The Fear of Pain

In studies unrelated to PRT, researchers found that the first component of PRT, pain neuroscience education, provided an effective way to trigger short-term improvements in pain levels, as well as limit disability, kinesiophobia, and pain catastrophizing.

Essentially, the fear of pain appears to play a large role in the perception of pain. By worrying about hurting themselves, participants were increasing the severity of the pain.

Woman suffering from back pain during medical exam Albina Gavrilovic / Getty Images


Other Effects

While further research is necessary, some evidence supports PRT as a treatment option for osteoarthritis, even after major surgery. These projections come from studies of pain neuroscience education and how it affects people with osteoarthritis who will be receiving total knee replacements.

Educating patients about the fear of movement and pain could not only help lower their perceived pain levels but also make them more confident about their upcoming surgeries. Since the first component of PRT is effective, the entire treatment method could provide even greater results.

therapist massaging senior man's knee Zinkevych / Getty Images


What to Expect

Depending on the participant and therapist’s needs and expectations, PRT can vary from person to person. Generally, the therapy involves hour-long sessions twice a week for four weeks. During these sessions, a therapist will teach their patient how to identify the causes of pain and reappraise pain sensations.

As treatment progresses, patients also learn techniques that allow them to address psychogenic issues that could worsen pain and ways to boost positive emotions.

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The Role of Mindfulness

One of the core components of PRT involves lessening pain sensations by limiting the fear and anxiety of pain. Essentially, this is a type of mindfulness where a person becomes more aware of the physical and structural reasons for pain —or the lack of such factors. Remaining positive not only lessens the perception of pain but also improves long-term outlooks for PRT.

These concepts are very similar to the key ideas of meditation, mindfulness, and yoga for pain relief, which therapists have used and recommended to great effect for many years.

woman and physiotherapist Javier Sánchez Mingorance / EyeEm / Getty Images


Costs and Other Considerations

Ultimately, costs will vary depending on location, required services, and many other factors. However, many health insurance plans will cover some of the cost of PRT, despite it being a new treatment option. This is because this therapy is a form of physical and psychotherapy.

Medicare, as one example, covers 80% of both mental health care and psychical therapy. Many PRT providers will also offer reduced or sliding scale rates.

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