A woman in her 50s had been experiencing fibromyalgia pain for many years. She had tried a variety of treatments, including medication and physical therapy, with limited success. After starting pain reprocessing therapy, she realized that her pain was linked to unresolved emotional trauma from childhood abuse. As she processed these emotions and learned to manage her stress, her pain gradually decreased, and she reported feeling more relaxed and less fatigued.
A man in his 50s had been experiencing chronic lower back pain for several years. He had been diagnosed with a herniated disc and had tried various treatments, including surgery, with no relief. After starting pain reprocessing therapy, he realized that his pain was linked to stress and anxiety about his job. As he learned to manage his stress and process his emotions, his pain gradually decreased.
A man in his 40s had been experiencing chronic foot pain for over a year. He had been diagnosed with plantar fasciitis and had tried various treatments, including cortisone injections, with little relief. After starting pain reprocessing therapy, he realized that his pain was linked to feelings of depression and hopelessness about his job and his life in general. As he worked through these emotions, his pain gradually decreased, and he reported feeling more energized and motivated.
Pain Reprocessing Therapy (PRT), a treatment rooted in neuroscience, is providing hope to individuals suffering from chronic neuroplastic pain—pain in the absence of an injury or that persists long after an injury has healed. PRT teaches patients to unlearn their chronic pain by reconceptualizing it as a brain-generated false alarm.
Psychotherapist Alan Gordon, PRT pioneer and director of the Pain Psychology Center in Los Angeles, and neuroscientist Alon Ziv explain the ins and outs of PRT in their book, The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain.
Gordon shares his own story of overcoming chronic back pain on episode 47 of Dr. Joe Tattta’s Healing Pain podcast.
How does Pain Reprocessing Therapy work?
PRT utilizes somatic tracking which teaches the brain to reinterpret signals from the body. Gordon and Ziv describe somatic tracking as way to “flip the script” on chronic pain. By doing this, pain sufferers are able to view their pain through a “lens of safety” rather than through a “lens of danger.”
PRT somatic tracking has three elements:
- Mindfulness
- Reappraising sensations as safe
- Generating positive emotions
Are there any clinical studies on PRT?
A randomized clinical trial published in JAMA Psychiatry in September 2021, found that “Patients randomized to PRT reported substantial reductions in pain intensity at posttreatment compared with both control groups.”
The study—the first of its kind– was funded in part by the NIH’s National Institute on Drug Abuse (NIDA). It included 151 people with mild to moderate chronic back pain for which no physical cause could be found. Participant received one of three treatments:
- four weeks of intensive PRT
- a placebo injection of saline into the back
- a continuation of care as usual.
After 4 weeks of PRT:
- 66% of people who received PRT reported being pain-free or nearly pain-free
- 20% of people who received placebo injections reported being pain-free or nearly pain-free
- 10% of those receiving usual care reported being pain-free or nearly pain-free
When follow ups were conducted one year later, reductions in pain had been largely maintained by participants who received PRT.
According to study co-author Dr. Tor Wager, “This isn’t suggesting that your pain is not real or that it’s ‘all in your head,’ What it means is that if the causes are in the brain, the solutions may be there, too.”
Co-author Dr. Yoni Ashar, said, “For a long time, we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that. This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain. Our study shows it works.”
To learn more about pain reprocessing therapy, the Alternative Pain Treatment Directory spoke with Dr. Amy Kossoff. Dr. Kossoff has been practicing Internal Medicine for more than 30 years, and in 2017, she completed a Fellowship in Integrative Medicine. She is also a certified hypnotherapist and a licensed acupuncturist. For the majority of her career, she has provided care to the underserved and homeless.
Approximately three years ago, Dr. Kossoff was given a copy of Healing Back Pain: The Mind-Body Connection, a book written by the late Dr. John Sarno. Sarno, a pioneer in the field of mind-body medicine practiced at New York University’s Rusk Institute of Rehabilitation. He believed that back pain was often the result of a psychosomatic process and emotional factors. Sarno coined the term Tension Myositis Syndrome (also called Tension Myoneural Syndrome or Mind Body Syndrome) to refer to psychosomatic pain—pain created by the mind to repress subconscious thoughts, feelings, or emotions. He believed that it was possible for some people to overcome their pain by acknowledging its psychosomatic origins and dealing with the emotions that caused it.
“I read his book, and it made a lot of sense to me,” said Dr. Kossoff.
After reading Sarno’s book, Kossoff read an article written by Dr. Howard Schubiner, director of the Mind Body Medicine Center at Ascension Providence Hospital in Southfield, Michigan. Dr. Schubiner’s Mind Body Medicine is based on the theory that chronic pain is often caused by psychological factors such as stress, anxiety, and repressed emotions. The therapy itself seeks to help individuals identify and address these factors in order to reduce physical tension and chronic pain. His book, Unlearn Your Pain, provides a 28-day process for reprogramming the brain.
After reading the article, Kossoff took an online pain reprocessing therapy training course taught by Schubiner and Australian pain psychotherapist Hal Greenham through Freedom From Chronic Pain. She then took another course taught by Schubiner and psychologist Mark Lumley. Schubiner and Lumley are authors of Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review.
“They (Schubiner and Lumley) developed Emotional Awareness and Expression Therapy (EAET), which is a combination of all of these different types of therapies that they have distilled down to something that is simpler and easier for people to learn—especially for people like me who aren’t therapists,” said Kossoff.
In addition to taking those courses, Kossoff received her certification from the Center for Mind-Body Medicine (CMBM). CMBM trains service providers to teach simple stress-relief and resilience-building skills in the context of small, supportive groups.
When discussing PRT and EAET, Kossoff said it is important to note that these therapies do not minimize a patient’s pain.
“All pain is real. All pain is generated in the brain. That is the bottom line in all of this. It’s not in anyone’s head. You’re not making it up. Making that distinction is so important.”
“If your brain realizes that you don’t want to have difficult emotions, it can cause you to have pain in order to distract you from those emotions. The more you worry and focus on the pain, the more your brain gets confused and thinks it’s dangerous to you and that it needs to make you feel it at a lower threshold. And then the pain gets worse, and you focus on it more. That makes the pain get even worse.”
As part of PRT, patients are encouraged to perform daily positive affirmations.
“Get up in the morning and say, ‘I’m strong. I’m healthy. I’m safe.’ Tell your brain to turn off the pain. You can make up affirmations that make your brain believe that you are okay,” said Kossoff.
During a session, a patient may be asked to close their eyes and imagine their pain. They are then asked to imagine their pain getting better or worse.
“By doing this, their pain will get worse or better,” she said. “That serves to demonstrate to people in real time that you can make your pain better or worse by using your brain. That’s basically the gist of pain reprocessing therapy—let’s teach your brain to make it better.”
As part of EAET, patients are encouraged to recall a conflict person and situation and express their underlying emotions to that person, using words, voice tone, facial muscles, and body.
“EAET is basically a type of therapy that helps people go back to traumatic events in their lives and reframe memories by expressing emotions to the people who harmed them,” explained Kossoff.
When asked what patients can expect when seeking PRT and EAET, Kossoff said the first session is the longest, typically lasting at least two hours. During that time, Kossoff conducts an extensive assessment of a patient’s pain and trauma history.
“We also do predictive testing which works if they have any kind of trigger for their pain. You see if you can get them to make it worse or better just by thinking about it,” she said. “At the end of the first session, we do something called somatic tracking where you try to observe your pain from a distance.”
Dr. Kossoff used the example of someone who suffers from back pain to illustrate the technique. In most cases, the moment the person feels a twinge of pain, they are filled with a sense of dread of what is to come.
“They go into that fight or flight state,” she said. “So, you just kind of suggest that they try to distance themselves from the pain and just observe it. They can say, ‘Oh, there’s my back pain. What is it doing? Maybe I can talk to my brain and tell it to go away.’”
Even though she’s the first to admit that PRT techniques may sound “silly,” she said PRT has cured many people of their chronic pain. The only caveat is that the patient must be open to the possibility that the treatment could help them.
Kossoff has seen just a small number of patients since receiving her training but said the results have been dramatic. One of her patients, a Ukrainian woman in her 30s, began experiencing severe abdominal pain in February 2022—the same month that Russia declared war on Ukraine. The woman is pursuing her PhD in the United States, but her mother as well as other family members and friends remain in the Ukraine.
“Her pain was completely incapacitating,” said Kossoff. “It was all day, every day.”
Even though the woman saw countless doctors and received blood tests, ultrasounds, an endoscopy, a colonoscopy, CT Scans, and even an MRI of the brain, the cause of her pain remained a mystery. She was eventually referred to Kossoff.
It didn’t take long for Kossoff to realize that the woman was dealing with an inordinate amount of trauma due to the war in her home country. In addition to worrying incessantly about the safety of her family and friends, she feels guilty that she is not there with them.
After just a few treatment sessions conducted via Zoom, Kossoff said the woman’s pain was significantly reduced. It now occurs only about once a week.
“She still has constant worry, but more and more, she is able to get the pain to go away. We’ve met five times, but she started seeing improvement after the first time. We accomplished that mostly with the pain reprocessing therapy along with some writing. Sometimes it can be really helpful for people to write. The people she’s angry at are the Russians, so that makes it hard to do the EAET because you need to be able to direct the anger more at a specific person.”
Although PRT and EAET are not intended to treat acute pain, they can be used to treat a wide variety of pain conditions.
“It works really well for fibromyalgia. I have a protocol for an 8-week group for fibromyalgia patients which I plan to do,” said Kossoff. “It also works for migraines, headaches, back pain, neck pain, and many other types of pain.”
For those who are interested in learning more about PRT, Kossoff suggests reading Dr. Schubiner’s book, Unlearn Your Pain, and Alan Gordon’s book, The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain.”
To schedule a virtual appointment with Dr. Kossoff, contact her at 301-502-1696 or Amykossoff@1440health.com.
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Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.
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