Pain Reprocessing Therapy Coaching
Persistent pain despite normal scans. Symptoms that shift with stress. Treatments that help briefly, then stop. This pattern has a name, a mechanism — and a path out that most people with chronic pain have never been offered.
JAMA Psychiatry, 2022
JAMA Psychiatry, 2025
Signs your pain may be neuroplastic
Normal scans, real pain. Tests show nothing — or nothing that explains what you feel.
Pain that moves or shifts. Location, intensity, or character changes — especially with stress, mood, or context.
Multiple treatments, no lasting relief. Something always helps temporarily. Nothing resolves it.
Fear of the pain feeds the pain. Anticipation, monitoring, and bracing seem to make it worse.
Pain that responds to emotion. A good day, an absorbing activity, or genuine rest brings noticeable — if temporary — relief.
Understanding Your Pain
Neuroplastic pain — also called nociplastic pain or primary chronic pain — is chronic pain generated not by ongoing tissue damage, but by a brain that has learned to interpret safe body signals as dangerous.
This is not imagined pain, and it is not weakness. It is the nervous system doing exactly what it was designed to do: protecting you from a perceived threat. The problem is that the threat pattern was learned — often during a period of injury, stress, or emotional upheaval — and the nervous system is now responding to signals that no longer require protection.
Research from the National Institutes of Health and published in JAMA Psychiatry confirms that in approximately 85% of chronic back pain cases, no identifiable peripheral cause can be found. The same pattern extends to fibromyalgia, chronic neck pain, widespread pain syndromes, tension headaches, and many other presentations where structural explanations fall short.
The crucial insight — and the reason this matters for your recovery — is that what the brain has learned, the brain can unlearn. Neuroplastic pain is not permanent. It is not a fixed feature of your body. It is a trained pattern in the nervous system, and trained patterns can be updated.
Key Distinction
Neuroplastic pain is completely real — it is felt in the body, can be debilitating, and is visible in brain imaging. The distinction is not between real and imagined pain. It is between pain caused by ongoing tissue damage, and pain caused by a nervous system that has learned to stay in alarm mode.
These indicators are drawn from the clinical PRT assessment framework. They do not replace medical evaluation — always rule out structural causes with a qualified physician first.
The fear-pain-fear cycle
PRT works by interrupting this cycle at step 2 — changing the brain’s threat appraisal of pain rather than targeting the sensation itself.
The Mechanism
Your brain’s primary function is not thought or feeling — it is threat detection and response. Pain is one of its most powerful tools for drawing your attention to something it has classified as dangerous.
In acute injury, this is precisely the right response. The pain signals tissue damage and motivates protective behaviour. But the nervous system is not designed for accuracy — it is designed for speed. And under sustained threat or chronic stress, it can make an error: it continues to signal danger after the original cause has resolved, or signals danger in response to stimuli that were associated with a past threat but are not dangerous in themselves.
Once that pattern is established, it can sustain itself. Every time pain arrives and is interpreted as threatening, the nervous system’s threat response is reinforced. The fear itself becomes fuel for more pain. This is the fear-pain-fear cycle — and it is the central target of Pain Reprocessing Therapy.
The good news, demonstrated by fMRI imaging in the JAMA Psychiatry trial, is that this cycle produces measurable changes in brain activity — and those changes are measurably reversible. Participants who underwent PRT showed significant reductions in pain-related brain activity in the anterior insula, the anterior midcingulate cortex, and the anterior prefrontal cortex. The brain that learned to amplify pain can also learn to quieten it.
Pain Reprocessing Therapy
Pain Reprocessing Therapy (PRT) is a structured psychological approach that helps the brain unlearn neuroplastic pain. It was developed by Alan Gordon LCSW at the Pain Psychology Center in Los Angeles and validated in the largest randomised clinical trial of a psychological treatment for chronic pain ever conducted.
PRT is not about managing pain. It is not about distraction, acceptance, or coping. It is explicitly designed to eliminate pain by changing the brain processes generating it — a fundamentally different goal from most existing chronic pain treatments.
It works by helping the brain do two things: first, understand that the pain does not indicate ongoing tissue damage; and second, experience that body sensations can be encountered safely without triggering the alarm. These two shifts — cognitive reattribution and somatic safety — work together to break the fear-pain cycle from the inside.
Understanding the mechanism — how the brain generates pain, what neuroplasticity means, and why current pain does not equal structural damage — is itself therapeutic. The research shows that shifting a person’s pain attribution from “body damage” to “brain process” predicts pain reduction directly.
Working with your specific history, triggers, and patterns to build a personalised case for the neuroplastic origin of your pain. This is not generic — it uses your own evidence to challenge your nervous system’s current threat model.
The core technique of PRT. Somatic tracking means attending to pain sensations with curiosity and openness rather than fear — learning to observe the sensation as information rather than threat. With repetition, this changes the brain’s automatic response to the pain signal.
Emotions — especially those that are suppressed or unresolved — can sustain nervous system activation and contribute to pain cycles. PRT includes gentle work on emotional contributors, without requiring deep trauma processing.
Deliberately attending to pleasant, safe sensations and experiences helps the nervous system form new neural pathways — building a competing pattern of safety alongside the pain pathway.
vs. CBT for pain
Physio works on the body. PRT works on the brain’s interpretation of body signals. Both are valid for structural pain — PRT is specifically designed for the neuroplastic kind.
vs. “It’s all in your head”
PRT does not dismiss pain as imaginary. It explains the real, neurobiological mechanism behind it — and uses that explanation as the basis for genuine, measurable relief.
vs. Mindfulness
Mindfulness builds present-moment awareness. Somatic tracking uses that awareness specifically to reappraise pain sensations as safe — a targeted application, not general practice.
Vs. physiotherapy
CBT typically aims to help people cope better with ongoing pain. PRT aims to eliminate it — a fundamentally different goal and a different treatment target.
PRT was developed by Alan Gordon, LCSW at the Pain Psychology Center in Los Angeles, building on the work of neurologist and pain researcher Dr. Howard Schubiner and neuroscientist Prof. Tor Wager at Dartmouth. The foundational trial was conducted at the University of Colorado Boulder (2017–2018) and published in JAMA Psychiatry in 2022.
The Research
PRT is the most rigorously tested psychological treatment for chronic pain. The evidence base now spans an initial randomised controlled trial, a five-year follow-up, neuroimaging data, and independent replication studies.
Improved after PRT — virtually every participant showed meaningful pain reduction. The median pain score dropped from 4.1/10 to 1.6/10 post-treatment.
Treatment gains maintained at five-year follow-up (Ashar et al., JAMA Psychiatry, October 2025). Significant improvements in pain intensity, interference, depression, and fear of movement still present.
Sources: Ashar YK et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13–23. Ashar YK et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025 Oct 1;82(10):1049–51. Ashar YK et al. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain. JAMA Network Open. 2023;6(9):e2333846. NIH Research Matters. Retraining the Brain to Treat Chronic Pain. 2021.
Self-Assessment
There is no single definitive test for neuroplastic pain — but the clinical PRT assessment framework uses a set of well-validated indicators. The more of the following that apply to your experience, the more likely it is that PRT coaching would be a meaningful path forward.
Pain with normal or inconsistent investigation results
Scans, blood work, or specialist assessments have found nothing — or found findings that are common in pain-free people too, like mild disc degeneration.
Pain that began during or shortly after a stressful period
Even if a physical event preceded it, the timing of onset — or of significant worsening — coincides with emotional or life stress rather than mechanical injury alone.
Symptoms that vary with your emotional state
Good days and bad days that seem to track with your mood, workload, or anxiety rather than with physical activity levels.
Pain that responds to distraction or absorption
When genuinely engaged in something meaningful, the pain recedes — not completely, but noticeably. This is a hallmark of centrally mediated pain.
Pain that has spread or generalised over time
What started in one location has expanded, migrated, or been joined by other symptoms — tension, fatigue, gut issues, headaches — without clear structural explanation.
Multiple unsuccessful treatments in the body
Physiotherapy, injections, surgery, massage, acupuncture — all have offered some relief, none have offered resolution. The problem keeps returning.
The Coaching Process
PRT coaching with Jan is structured, compassionate, and paced entirely to your nervous system. It is not a fixed script — but there is a consistent arc that every client’s work moves through.
Sessions are conducted online via secure video. Each block is four sessions of 60 minutes, usually across one month. Coaching continues on a monthly basis until you feel you no longer need it — there is no minimum commitment beyond the first block.
Many clients notice meaningful shifts within the first two to four sessions. Full resolution of chronic pain takes longer — typically several months — and is supported by the skills and perspective developed in session, which you carry and use independently between meetings.
“I deeply believe in the neuroplastic capacity of the brain and nervous system. They are not fragile systems that break easily. They are adaptive systems that learned how to protect us — and they can learn something new when that protection becomes more limiting than helpful.”
Jan Krueder spent years supporting executives through pressure and high performance before the common thread became undeniable: the capacity that determines how well someone leads — or simply lives — is nervous system capacity. That recognition led him to specialize in Pain Reprocessing Therapy, nervous system regulation, and the Energy Leadership work that makes the patterns visible.
His approach is not clinical distance. It is steady, informed presence — a coaching relationship in which your experience is taken seriously, the science is applied rigorously, and your nervous system’s pace is respected throughout.
Why Work With Jan
Working with chronic pain requires more than a protocol. It requires a coaching relationship in which the nervous system feels safe enough to change. Jan brings both the clinical structure of PRT and the human warmth that makes that change possible.
Jan is certified in Pain Reprocessing Therapy by the Pain Psychology Center in Los Angeles — the organisation that developed and validated PRT. This is not a broadly trained “pain coach” offering PRT-adjacent content.
PRT does not stand alone in Jan’s work. It is integrated with somatic tracking, window-of-capacity work, and the Energy Leadership Index — a fuller picture of the nervous system than PRT alone addresses.
Nervous system change does not follow a calendar. Jan works with the pace that your system allows — not pushing for breakthroughs, but creating the conditions in which they become possible.
If you’ve tried everything and still have pain, you don’t need another practitioner who implies you haven’t tried hard enough. Jan starts from where you actually are — not where you “should” be.
Frequently Asked Questions
Neuroplastic pain (also called nociplastic pain or primary chronic pain) is chronic pain generated not by ongoing tissue damage, but by a brain that has learned to interpret safe body signals as dangerous. The pain is entirely real — felt in the body, visible in brain scans, and often debilitating. The distinction matters because neuroplastic pain is fully reversible: the brain that learned the pain pattern can also unlearn it. This is the central premise of Pain Reprocessing Therapy.
Key indicators include: pain that persists despite normal investigation results; symptoms that shift or intensify with stress or emotion; pain in multiple locations or that migrates over time; onset during or following a stressful period; and multiple treatments that have helped temporarily but not resolved the problem. Neuroplastic and structural pain can coexist — having a structural finding on a scan does not rule out neuroplastic contribution. The first step is always a full medical evaluation to investigate structural causes; PRT coaching is appropriate once those have been explored.
PRT has the strongest evidence base for chronic back pain, where the original JAMA Psychiatry trial was conducted. Beyond back pain, PRT is increasingly applied to — and showing promising results for — chronic neck pain, fibromyalgia, tension headaches and migraines, widespread pain syndromes, pelvic pain, abdominal pain, and many other conditions where neuroplastic mechanisms play a significant role. The unifying criterion is not the location of pain but its mechanism: pain that is sustained by the nervous system’s learned threat response rather than by active structural damage.
Yes. This is one of PRT’s most distinctive features — unlike many treatments that require ongoing use, PRT appears to produce durable change because it works at the level of the brain’s threat model rather than at the level of symptom management. The original JAMA Psychiatry trial (2022) showed gains maintained at one-year follow-up. A five-year follow-up published in JAMA Psychiatry in October 2025 confirmed that participants who received PRT still showed significant improvements in pain intensity, pain interference, depression, anger, and fear of movement. Lead researcher Dr. Yoni Ashar summarised: “In the original trial, we showed that a lot of people got a lot better. The five-year study shows they mainly stayed better.”
Physiotherapy targets the body — muscles, joints, movement patterns. It is well-suited for structural pain but less effective when the pain is primarily neuroplastic. Psychologists may offer CBT for pain, which typically aims to help people cope better with ongoing pain rather than eliminate it — a fundamentally different goal. PRT is explicitly aimed at teaching the brain to stop generating the pain signal, not at building better coping strategies for living with it. Jan’s coaching integrates PRT with nervous system regulation work and the Energy Leadership framework — a broader picture than PRT alone, addressed through a structured coaching relationship rather than a clinical therapy model.
Sessions are 60 minutes, online, once a week within a monthly block of four. Each session follows the PRT framework while remaining responsive to what is actually happening for you that week. Early sessions focus on understanding your specific pattern and its nervous system drivers. As the work deepens, sessions move into guided somatic tracking, fear-reduction work, and expanding what your system will allow. Between sessions, you practice the techniques introduced in the session — small, realistic experiments rather than homework. There is no rigid script; the arc is consistent, the pace is yours.
Conditions Addressed
PRT was originally validated for chronic back pain but the neuroplastic mechanism applies across a wide range of persistent pain presentations where central sensitisation and fear-based maintenance are significant contributors.
Ready to Begin
Pain Reprocessing Therapy is not a last resort. It is a specific, evidence-based approach to a specific kind of pain. If yours fits the pattern — and for most people with persistent, unexplained chronic pain it does — there is a genuine path forward.
