PRT · A treatment for chronic pain

Pain Reprocessing
Therapy

PRT is a therapy that helps the brain reduce chronic pain when no injury is enough to explain it.

Here is what it is, what treatment involves, and what the research shows.

Take the testSee the results
Pain free or nearly pain free
66%
Experienced a reduction in pain
98%
Improvements persisted
1 yr+

What PRT is

Teaching the brain that pain is not always a sign of damage

Pain Reprocessing Therapy (PRT) is a psychological treatment for chronic pain that is not fully explained by a clear structural cause. It is based on the idea that pain can be maintained by brain processes related to how sensations are interpreted, as well as by learning and emotions.

The idea is simple: if the brain has learned to produce or amplify pain, it can also learn to reduce that response. PRT helps people change how they interpret and respond to painful sensations, with the aim of gradually reducing pain.

The treatment

What happens in treatment

In the Boulder trial, treatment combined a medical assessment and education session with eight individual therapy sessions over four weeks. The therapy used four main types of techniques:

  1. 01

    Personalized assessment

    A physician assessed whether the pain was more likely to be related to an identifiable physical problem or to changes in how the nervous system processes pain. The findings were then discussed with the patient.

  2. 02

    Reappraisal of sensations

    Patients learned to reinterpret pain sensations as safe, including while engaging in feared postures or movements.

  3. 03

    Addressing psychosocial threats

    Techniques addressed difficult emotions and other psychosocial factors that could amplify pain.

  4. 04

    Positive emotions and self-compassion

    Techniques were used to increase positive emotions and self-compassion.

Source: Ashar et al., JAMA Psychiatry, 2022.

The results

What the research shows

The Boulder trial was the first randomized clinical trial of PRT. It included 151 adults with chronic back pain who were randomly assigned to PRT, placebo, or usual care. After four weeks, 98% of participants in the PRT group experienced a reduction in pain, and 66% were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% in the usual care group. The improvements were largely maintained one year later.

Sources: Ashar et al., JAMA Psychiatry, 2022; Pain Reprocessing Therapy Center.

FIG 1

Pain free or nearly pain free after treatment

Participants who rated their pain 0 or 1 out of 10 after treatment.

100%75%50%25%0%66%Pain reprocessing33 of 5020%Placebo10 of 5110%Usual care5 of 50
Of those assigned to PRT, 33 of 50 (66%) were pain free or nearly so. That is 73% of the 45 who actually started therapy. Placebo reached 20% and usual care 10%.

FIG 2

Pain stays low for a year

Average pain intensity (0 to 10) before treatment, right after it, and one year later.

  • Pain reprocessing
  • Placebo
  • Usual care
012345Pain intensity4.21.21.5BaselineAfter treatment1 year later
After treatment, average pain in the PRT group fell from 4.2 to 1.2 out of 10 and was still 1.5 a year later. Placebo and usual care groups stayed near 3.

Studies on PRT

  • 2022 · JAMA PsychiatryAshar et al., the Boulder trial

    Pain Reprocessing Therapy vs placebo and usual care for chronic back pain

    66% of the therapy group were pain free or nearly so, vs 20% on placebo and 10% on usual care, with gains largely maintained at one year.

    RCT

  • 2023 · JAMA Network OpenAshar et al.

    Reattribution to mind-brain processes and recovery from chronic back pain

    Secondary analysis of the Boulder trial. Recovery was linked to people coming to see their pain as driven by mind-brain processes rather than tissue damage.

    Secondary analysis

  • 2025 · Reg Anesth Pain MedSturgeon et al.

    Brief pain reprocessing therapy for fibromyalgia: a feasibility, acceptability, and preliminary efficacy pilot

    A short form of PRT in three one-on-one remote sessions, in 35 people with fibromyalgia, with no comparison group. 94% completed the program, and pain fell among those who did. A randomized trial is needed to confirm it.

    Pilot trial

  • 2026 · J Psychosom ResSit et al.

    Pain Reprocessing Therapy in chronic widespread pain

    Feasible in primary care (n = 53). 30% vs 12% reached a 2 point reduction in pain severity; trends favored the therapy on every secondary outcome.

    Pilot trial

  • In progress · NCT07287072University of Oslo

    PRIME-PRT: Pain Reprocessing Therapy in primary care

    Norwegian primary care trial of PRT in adults aged 18 to 70 with chronic pain and no clear physical cause, probably nociplastic. Recruitment has closed and results are not yet published.

    Registered
See all studies

Could this work for you?

Answer a few questions about your pain. It takes about two minutes.

Take the test