Pain Reprocessing Therapy for Chronic Back Pain: What the Science Shows
Pain Reprocessing Therapy for Chronic Back Pain
Chronic back pain can take over your days, your energy, and your sense of control. But here’s the truth many people never hear:
Pain doesn’t always mean damage.
Often, chronic back pain is the result of a protective nervous system. A protective nervous system has learned to stay on high alert, even when your body is structurally safe. Pain Reprocessing Therapy (PRT) is an evidence-based approach that helps retrain the brain to interpret sensations accurately so the body can return to a state of safety. And the research, especially for chronic low back pain, is incredibly encouraging.
If you’re navigating persistent back pain and feeling frustrated by imaging results, flare-ups, or conflicting advice, this guide is for you.
What Is Pain Reprocessing Therapy (PRT)?
PRT is a structured mind-body approach that helps reduce or eliminate chronic pain by:
- Teaching the brain that sensations are safe
- Reducing fear around movement and pain
- Helping the nervous system shift out of a “danger” state
- Supporting emotional awareness and regulation
- Building new neural pathways that wire in safety
PRT is especially effective for primary chronic pain—pain driven by neural circuits rather than tissue damage.
To learn more about primary pain, visit: Understanding Chronic Primary Pain: What It Is, Why It Happens, and How You Can Heal.
The Boulder Back Pain Study: A Breakthrough in Chronic Pain Treatment
One of the most compelling studies on PRT was conducted at the University of Colorado Boulder in 2021. Here’s what you need to know.
Study Overview
- Participants: 151 adults with chronic back pain (average duration: 10 years)
- Intervention: 4 weeks of PRT (8 sessions)
- Comparison groups: Usual care and placebo
- Goal: Determine whether retraining the brain’s response to pain reduces chronic back pain
Key Results
After just 4 weeks of PRT:
- 66% of participants were pain-free or nearly pain-free
- Pain reductions were far greater than both placebo and standard care
- Brain imaging showed decreased activity in pain centres—the brain was literally learning safety
This was the first study to demonstrate both clinical and neurological changes from a psychological-based pain treatment.
Long-Term Results: 1-Year and 5-Year Follow-Up
One of the biggest concerns for patients is: “Even if this helps, will it last?”
Good news! YES!
1-Year Follow-Up
- Most participants maintained substantial reductions in pain
- Many continued to be pain-free
- Improvements in function, mood, and activity levels remained stable
5-Year Follow-Up
(2024 follow-up data)
- The majority of participants retained meaningful pain relief
- Many reported continued confidence in movement
- No evidence of worsening symptoms or “relapse”
- Participants who continued using PRT skills reported the best long-term outcomes
This shows that when the nervous system learns safety, it tends to stay there, especially if you keep practicing the skills.
Why MRI Findings Don’t Always Predict Pain
Many people with back pain fear their MRI results. But one of the most reassuring pieces of research comes from Brinjikji et al., 2016, which looked at over 3,300 pain-free people of all ages.
They found that many “abnormal” MRI findings are simply a normal part of aging:
- Disc degeneration: 52% at age 30 → 88% at age 60
- Disc bulges: 40% at age 30 → 69% at age 60
- Disc protrusions: 31% at age 30 → 38% at age 60
- Arthritis/facet changes: increase steadily across the lifespan
- Spondylolisthesis: 5% at age 30 → 23% at age 60
These people had ZERO pain.
This study helps us understand that many imaging “findings” represent natural structural changes—not injuries, threats, or causes of chronic back pain.
To read more about imaging and pain, you can visit [link: “Why MRI Results Don’t Always Explain Pain: What the New Science Really Shows
What to Expect in PRT — And How to Support It
While PRT is powerful, it works best when approached with openness, consistency, and patience. Here’s what helps:
- Mindful awareness of sensations (noticing without fear)
- Gentle movement and exposure to activities once avoided
- Reappraisal of pain’s meaning: shifting from “danger” to “sensitivity”
- Emotional regulation and nervous system calming (breath work, grounding)
- Daily consistency — small steps repeated over time often lead to large shifts
For many, PRT isn’t a quick “fix.” But over weeks or months, it can fundamentally change how your brain experiences and interprets pain, often leading to lasting relief.
Is Pain Reprocessing Therapy Right for You?
You may benefit from PRT if:
- You have chronic back pain that has lasted months or years
- Imaging (X-rays, MRI) shows no major structural damage, or damage doesn’t match pain severity
- Pain seems triggered or amplified by stress, emotion, movement-avoidance, or fear
- You are open to a mind-body, neuroscience-based approach
- You want long-term relief — not just short-term masking
If that sounds like you, PRT offers a science-backed, compassionate path toward healing.
Final Thoughts: Healing Is Possible—and Backed by Research
Chronic back pain doesn’t have to be a life sentence. Emerging research from the Boulder Back Pain Study and its 5-year follow-up shows that many people can find significant, lasting relief — not through surgery or ongoing medication, but through rewiring their brain and nervous system.
If you’re ready to explore a new paradigm, one rooted in safety, understanding, and research, Pain Reprocessing Therapy might just be the path your body and brain have been waiting for.
> You can learn more about working together here.
References:
Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, A. J., Anderson, Z., … & Wager, T. D. (2021). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 78(11), 1–11.
Ashar, Y. K., et al. (2022–2024). Long-term follow-up of pain reprocessing therapy for chronic back pain (1-year and 5-year data). University of Colorado Boulder Pain Research Lab.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.
Free Resource: Daily Nervous System Regulation Guide
If you’re ready to bring these ideas into practice, download our free Daily Nervous System Regulation Guide — a simple, gentle roadmap filled with daily rituals to help your body feel grounded and balanced.
