Pain Reprocessing Therapy is a primary treatment for neuroplastic pain.
Chronic pain with no structural explanation.
When the brain misinterprets safe signals from the body as if they were dangerous with the purpose of preventing further damage to the body.
I’ve shared valuable quotes from training, potential scripts you may hear within sessions for building safety through familiarity, and a roadmap to what this work may look like, again, for predictability to cue experiences of safety.
PRT’s underlying principle is that the brain interprets pain as dangerous.
A transcript from a role play may give some insight into what this approach may sound like in session, or in a mindful moment of awareness in private:
“We don’t care about stamping your pain out. We care about reframing what’s actually happening. Your [body part] is sending messages to the brain and your brain is going ‘Ahh!’
That’s all that the pain is.
This pain is safe. As you keep bringing gentle movement to [that part of your body]…
There is nothing structurally wrong. This is just your brain overreacting and it has perpetuated this story of danger, of damage.
How does it feel to turn to your [body part], feel the pain, and not care that you do, because you know that it is safe?…
You just proved it, because if there was something structurally wrong with you, you would not have been able to get the pain to go down just by changing your relationship with the interpretation of the sensation…
To get rid of chronic pain, all you have to do is change your understanding of what the actual sensation is…
And once you reframe it like that, the pain is no longer dangerous, and you could break twenty years’ worth of chronic pain once you cut off the vessel of reinforcement: fear.”
“Dizziness is a danger signal when we’re off balance. Nausea, fatigue, anxiety, dizziness, headaches can all be types of danger signals. And, just like with pain, the brain can misinterpret danger signals where there is none.”
“We are biologically wired to associate physical pain with physical injury, but without a structural issue and stories of avoiding or being overwhelmed by emotion, pain may be neuroplastic.”
“It’s great that you’ve been doing all the wrong things and seen no improvement, because if you had been doing all the right things and are still in pain after two years, where do we go from there? This gives us so much room for change. Here’s the reason I say you’ve been doing the opposite of what you should be doing: all of these things you’ve been doing, you’re reinforcing the messages of danger to your brain. The reason you have these symptoms in the first place is because your brain is shrouded with danger and because you are constantly preoccupied with it…
If every time you eat, you’re afraid of inflammation, if every time you walk around your house you’re afraid of mold or EMF pollution, your poor primitive brain is going to be in such a state of high alert that it is going to perpetuate these symptoms.
This drive, this pressure has really allowed you to be successful. But this is the one area where it is actually going to prevent you from being successful, because the more intense you are to try to fix this problem the more you reinforce messages of danger to your primitive brain.” Your homework is to try something new: to learn how to live in a state of ease.
“When you’re enjoying the day and existing in the moment, and not preoccupied with the pain, that’s when the pain goes away. This is not a leap of faith. This is a leap of evidence. All we need to do is to teach you to exist that way more regularly.”
Maybe progress looks like catching moments of temporary pain with mindful recognition:
Now when [temporary pain] comes on, I look at it as, this is my body’s way of letting me know I’m putting too much pressure on myself or I’m not attending to my inner state or I’ve kind of abandoned myself in some way. And thank you brain for letting me know that. And I’ll start treating myself better and I’ll slip back into enjoying the moment and the pain will fade.
Neuroplastic pain can develop from
- an initial injury
- a perceived initial injury
- a stressful situation
- a gradual onset of symptoms
Chronic pain is the result of learned neural pathways. “The big three” sources of fear that fuel pain are:
- worry
- pressure
- self-criticism
The path to knowing if something is structural or neuroplastic may include:
- Assessment begins with the first phone call
- Referral to a physician who specializes in diagnosing neuroplastic pain
- Collecting evidence pointing towards a neuroplastic pain diagnosis
The Approach
1. Mindfulness
- Can disrupt the pain-fear cycle and help the brain interpret signals correctly
- Increases feelings of safety
2. Safety Reappraisal may sound like:
- Close your eyes and make yourself comfortable. Bring your attention to the physical sensation in your ___ right now. What qualities do you notice?
- I know it feels like there’s something that’s going on in your body right now, but your muscles are all healthy. Your tendons are all strong. Your ligaments and your nerves are all perfectly intact. It’s simply that your brain is overreacting to a perfectly neutral, perfectly safe sensation.
- So see if you could pay attention to this sensation. You don’t need to change it. You don’t need to get rid of it. In fact, there’s nothing to even get rid of. It’s simply your brain making a misinterpretation.
- Pay attention to this really interesting [quality of sensation in a specific location], knowing that it’s totally safe. And explore it. You’re a passenger in the car, along for the ride. And what do you notice as you pay attention to this sensation…See if you can just follow it.
- Let’s let your amygdala know you’re actually safe right now.
3. Positive Affect Induction — being immersed in a positive emotional state through humor, stories, and analogies
- Exposure to the pain with a lens of safety
- Pain may decrease when you are authentically engaged in something that you enjoy
4. The Process
- At home, communicating messages of safety to the highest degree you can given the level of pain intensity at any specific moment, building more and more evidence for the brain to interpret the sensations with a lens of safety instead of threat
5. Somatic Tracking
- Helps to respond to pain with less fear
- Should not be used when pain is too severe in the moment, as exposure may prove more retraumatizing than offering a corrective experience. Instead, we would use an avoidance behavior until the pain can be viewed through a lens of safety again
- Asks sensation, what are you telling me right now? And then we slow down, practicing presence. Here, now, listening for whatever information your body shares with us for greater understanding.
- Take the pressure off yourself to do this perfectly. In this very moment ‘I’m safe.’ For this moment, being present here is the most productive thing I can do in the world.
- Scale 1-10, how much fear do you have towards your pain (how much do you resist it)?
- Scale of 1-10, how confident are you in your ability to regulate your nervous system at any given moment?
- No sensations are objectively positive/negative (ex. massage, hot tub) – takes power away
- I want you to describe the physical sensations as you breathe in and out. What’s it like as you breathe… Keep breathing and really explore it…Is it pleasant? Is it unpleasant? Is it neutral?
In session, we will:
- Identify the threat—the motion sensations
- Work on positive affect in present moment
- Work with reaction to the sensation
- Somatically tracking where and how the sensations of the reaction are experienced
- Prioritizing our time for primary emotional experiences instead of secondary experiences
- Example: Instead of frustration about the frustration, what would it be like to accept the original frustration
- Allowing for natural responses to sensation, anything that exists. Practicing not fighting it away or ignoring it.
- Leaning into a new relationship to the response with compassion, valuing its’ protective qualities.
- Allowing emotions…don’t need to fight them…they can come up for air
- What is arising—finding a way to relate to sensation and emotion positively, with lightness.
- Check in with original sensation
- Relate conscious mind with subconscious mind
- Celebrate the learning of a “different” association: sensation with positive affective experience
- Continue exploring evidence for safety, new adaptive framing of your sensational experience of living: Are there any positive or neutral sensations that we can relate to this?
Like with most growth, there may be what feels like 2 steps forward and 1 step back. An extinction burst occurs as fear and pain symptoms decrease, often a spike of intense pain follows temporarily.
I encourage you to notice what sensations just set off within you reading the first part of that last sentence? And, was there any change when you got the “temporarily?
Our defenses are like the same kid going home, changing costumes, and coming back for more of the same candy. They try hard to get what they want and use disguises to improve their odds.
RECOGNIZE what’s going on
REAPPRAISE the mind isn’t drawn to rumination or distraction because there is legitimate danger, rather it’s drawn towards what is familiar
REPLACE the messages of danger with messages of safety
Oftentimes people say “I can’t wait to get back to life before the pain” when in actuality life was probably intense leading the body to send signals of danger. We want to work towards building a more regular experience of ease and enjoyment in your life in the present and moving forward.
Life after pain will likely differ greatly from your experience of living any time before.
Healing isn’t about fixing a broken version of yourself—it is about learning how to come back home to the present moment. If you are ready to break the cycles of anxiety, perfectionism, or chronic pain, let’s take the first step together.
Book a consultation today to explore holistic, somatic psychotherapy at our Carlsbad, California practice.
