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Chronic Pain · 6 min read

Chronic Pain Therapy & Pain Reprocessing

Chronic pain is often a learned brain prediction — therapy retrains the alarm.

Originator: Alan Gordon (Pain Reprocessing Therapy, 2010s) · Howard Schubiner (Emotional Awareness & Expression Therapy)Best for: Primary chronic pain · Fibromyalgia · Chronic back pain · Tension headaches · TMD · Chronic pelvic pain

Core idea

A growing body of neuroscience reframes much chronic pain as nociplastic — generated and maintained by a sensitized central nervous system rather than by ongoing tissue damage. Therapy targets the predictive brain itself: building credible psychoeducation that the pain is real but safe, reducing fear-avoidance, and using somatic tracking to teach the brain that the sensation does not signal danger. Best evidence: Pain Reprocessing Therapy (PRT), Emotional Awareness & Expression Therapy (EAET), and CBT for chronic pain.

Key concepts

Nociplastic pain
Pain generated by altered central nervous system processing, not ongoing tissue damage (IASP, 2017).
Predictive coding
The brain generates pain as a prediction; expectation, threat appraisal, and prior experience shape it.
Fear-avoidance cycle
Pain → fear of movement → avoidance → deconditioning and hypervigilance → more pain.
Somatic tracking
Curious, low-stakes attention to the sensation while reinforcing safety — the core PRT move.
Pain reappraisal
Shifting the meaning of the sensation from danger to safe brain signal.

What a session looks like

  1. 1
    Pain education
    Explain nociplastic pain with credible imagery — the alarm wiring, not the tissue.
  2. 2
    Evidence gathering
    Collect personal data that the pain shifts with state, context, attention — evidence it is generated, not structural.
  3. 3
    Somatic tracking
    Brief, curious attention to the sensation while affirming safety; track shifts in real time.
  4. 4
    Avoidance reversal
    Graded re-exposure to feared movements and activities, paired with safety reappraisal.
  5. 5
    Emotional processing
    Surface and express avoided emotions (anger, grief) that the pain has been holding.

Signature techniques

Pain reprocessing somatic tracking
5–10 min of curious attention to the sensation, reinforcing 'this is safe' until intensity shifts.
Avoidance ladder
Rank avoided movements/activities; re-engage in graded steps with safety reappraisal.
Affective expression (EAET)
Identify and express avoided anger or grief tied to relational injuries that predate or compound the pain.
Outcome independence
Practice attending to the sensation without requiring it to change — paradoxically reduces threat.
Identity work
Loosen 'I am a pain patient'; rebuild values-based activity even while symptoms persist.

Evidence base

Boulder Back Pain Study (Ashar et al., JAMA Psychiatry 2022): 66% of PRT participants were pain-free or nearly pain-free at 1 year vs 20% placebo, 10% usual care. EAET meta-analyses show moderate-to-large effects on fibromyalgia and centralized pain. CBT for chronic pain has decades of RCT support for function and distress, smaller for pain intensity.

Common pitfalls

  • ▸Implying the pain is 'all in your head' — credible reframing is biological, not dismissive.
  • ▸Skipping rule-out — confirm with a physician that pain is primary/nociplastic before reprocessing.
  • ▸Pushing exposure before the safety appraisal is in place; floods the system and reinforces threat.
  • ▸Treating somatic tracking as a pain-reduction technique — outcome independence is the active ingredient.

Where to go next

The Way Out
Alan Gordon & Alon Ziv
Plain-language intro to PRT — share with clients.
Unlearn Your Pain
Howard Schubiner
EAET workbook with the 4-week protocol.
Explain Pain
Lorimer Moseley & David Butler
The pain neuroscience education classic.