Tanner Murtagh Tanner Murtagh

How Does Pain Become Chronic: Understanding and Reversing the Cycle

Chronic pain is not just a physical condition; it’s also a learned pattern in the brain. Similar to how we can learn to play the piano or speak a language with practice, our brain can, unfortunately, also learn to produce pain.

How the Brain Learns Pain

Repeated activation of pain signals strengthens neural connections in the brain, making the pain response more efficient over time7. This process, called central sensitization, can cause the nervous system to become overly responsive, leading to heightened sensitivity and long-lasting symptoms.

In one ground-breaking study, researchers looked only at brain scans to predict which patients would recover from back pain and which would develop chronic pain2. Increased connectivity between the nucleus accumbens and the prefrontal cortex was a strong predictor. This suggests that our brain’s response to pain plays a huge role in whether pain fades or lingers3.

The Nervous System’s Response to Pain

When pain strikes, many of us enter a state of nervous system dysregulation. This can show up in four main patterns:

  • Fight: frustration, anger, pushing through, over-fixing
  • Flight: fear, anxiety, hypervigilance, constant seeking of help
  • Fawn: people-pleasing, perfectionism, self-pressure
  • Freeze: despair, shutdown, helplessness, emotional numbing

These stress responses can reinforce pain signals, creating a feedback loop that keeps the pain cycle going. We call this feedback loop The Sensitization Cycle.

 
 

Fear and the Amplification of Pain

Two studies demonstrate how fear and perception can amplify pain:

  • The Scary Picture Study4 showed that people experienced more pain, and even felt pain without a stimulus, when viewing frightening images.
  • The Pain-Related Fear Study6 found that individuals with more fear about their pain were more likely to still have pain six months later.

These findings highlight a critical truth: pain is not always a direct reflection of tissue damage, it’s deeply connected to emotional and cognitive factors.

Breaking the Cycle: Evidence-Based Therapies

At Pain Psychotherapy, our goal is to help you shift out of the sensitization cycle and into the desensitization cycle, teaching the brain and body to feel safe again.

 
 

We utilize the following two therapy approaches, along with several others, to support clients in entering the desensitization cycle to heal their chronic pain or illness.

Pain Reprocessing Therapy (PRT)

In a landmark clinical trial, 98% of people receiving PRT reported pain reduction, and 66% became pain-free or nearly pain-free, even after an average of 10.7 years of treatment-resistant chronic back pain1. Brain scans showed reduced activity in pain-related brain areas.

Emotional Awareness and Expression Therapy (EAET)

In a study of 230 people with fibromyalgia, EAET significantly reduced widespread pain, with 22.5% of participants experiencing at least a 50% reduction in pain5. By helping clients identify and express emotions safely, EAET calms the nervous system and reduces pain.

Are You Ready to Heal?

Book in for a free 20-minute consultation with one of our therapists to begin your healing journey:

 

  1. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., 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.

  2. Baliki, M. N., Petre, B., Torbey, S., Herrmann, K. M., Huang, L., Schnitzer, T. J., ... & Apkarian, A. V. (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience, 15(8), 1117–1119.

  3. Gordon, A., & Ziv, M. (2021). The role of the brain in chronic pain. Pain Medicine, 22(2), 281–289.

  4. Kirwilliam, S. S., & Derbyshire, S. W. G. (2008). Increased bias to report heat or pain following emotional priming with fear. Pain, 137(1), 60–65.

  5. Lumley, M. A., Schubiner, H., Lockhart, N. A., Kidwell, K. M., Harte, S. E., Clauw, D. J., & Williams, D. A. (2017). Emotional awareness and expression therapy, cognitive-behavioral therapy, and education for fibromyalgia: A cluster-randomized controlled trial. Pain, 158(12), 2354–2363.

  6. Picavet, H. S., Vlaeyen, J. W., & Schouten, J. S. (2002). Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. American Journal of Epidemiology, 156(11), 1028–1034.

  7. Song, Q., Zhang, X., & Liang, Y. (2024). Neural mechanisms of chronic pain sensitization. Neuroscience Bulletin, 40(3), 211–223.

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Tanner Murtagh Tanner Murtagh

What is Pain Reprocessing Therapy?

 

Can PRT Help in Retraining my Brain out of Chronic Pain and Symptoms?

By Tanner Murtagh, MSW, RSW

For 3 and a half years I experienced widespread chronic pain that continued to worsen over time. To try and reduce or eliminate my chronic pain I did what most people do which included: being examined by several physicians, MRI and x-rays, physiotherapy, chiropractic work, pain medication, and several other physical treatments. However, all the medical tests and treatments did not resolve my pain and in fact, caused my pain to increase.

This is a common story I hear when providing therapy to clients with chronic pain or symptoms. “The medical system has failed me. No treatment is helping.”

The reality is that medical procedures have poor results when it comes to reducing or eliminating chronic pain and symptoms. Surgery, injections, and narcotic pain medications are no more effective than placebo or conservative treatments.1.

So, what is the solution to healing chronic pain and symptoms? The answer lies in the brain. Chronic pain, fatigue, dizziness, or other physical symptoms are often neuroplastic. Neuroplastic pain/symptoms are when the brain changes in such a way that it reinforces chronic pain/symptoms2,3.

When our brain or nervous system feels in emotional danger or dysregulated, chronic pain or symptoms can be triggered and perpetuated2,3. Over time, as pain or symptoms are repeatedly produced, the brain learns to generate these sensations better and better. It is vital to understand that a significant portion of chronic pain and symptoms are neuroplastic, meaning the brain is responsible for triggering and perpetuating them4.

For myself, after 3 and a half years of being in pain I came to understand that my symptoms were neuroplastic in nature. This realization allowed me to shift my focus to rewiring my brain instead of fixing my body. I began to utilize brain retraining exercises, in combination with emotional processing and nervous system regulation, and in doing so over several months I was able to become pain-free.

Research on Pain Reprocessing Therapy (PRT), which is a psychological approach focused on rewiring the brain out of chronic pain, has shown that reversing neuroplastic pain is possible5. In a clinical trial on PRT 66% of participants who received the treatment were able to become pain-free or nearly pain free after 9 sessions5. Over 98% of participants in the study had pain reductions. This research and my personal experience showcase how it is possible to retrain your brain out of chronic pain!

At our clinic we support clients in utilizing brain retraining practices from PRT to heal their chronic pain and symptoms. PRT brain retraining practices for chronic pain and symptoms can include:


Creating New Beliefs about Your Body, Pain, or Symptoms

Understanding that our symptoms are neuroplastic and our body is not permanently damaged is essential. At our clinic, we support people in looking for evidence that their pain or symptoms are in fact neuroplastic. We want to foster the belief that healing is possible. Retraining our brain to develop new beliefs about our body and symptoms, with less fear and more safety, can result in the sensations of pain or symptoms reducing over time 2.

Developing Cognitive Safety Messages

Fearful, frustrated, or despairing thoughts about our pain or symptoms can worsen the sensations2. Brain retraining can involve changing our thoughts about our symptoms by utilizing cognitive safety messages. These could include:

  • “I know I’m okay; my brain is just misinterpreting normal sensations in my body.”
    • “I see how my symptoms are inconsistent, moving around, and triggered by emotions. This shows me it’s neuroplastic and my body is healthy and capable.”
  • “I don’t need to control or change these sensations. There is nothing to fix or figure out!”
  • “My muscles and tendons are healthy. My nerves and ligaments are perfectly intact. My brain is just sensitized and overprotective.”
  • “It’s physically safe to move this way.”
  • “I don’t need to like the sensations; I just need to remember they’re safe!”

Using messages of safety consistently when you notice yourself having negative thoughts about your symptoms and body can support you in rewiring your brain2. In our clinic, we support people in creating unique messages of safety about their body.


Visualizing Yourself Healing and Moving Your Body

Visualization can be a supportive tool in rewiring the brain. Consistently visualizing yourself becoming pain or symptoms free, being able to approach life again, and being able to exercise and use your body the way you want to can support teaching your brain that your body is healthy and capable.


Somatic Tracking

Often, we have an emotional response of fear, frustration, despair, or annoyance to our pain or symptoms. This negative emotional response to our chronic symptoms can actually worsen our symptoms over time as it increases the level of danger and dysregulation our brain is experiencing2. Somatic tracking is a skill that can support us in changing our emotional response to our chronic pain or symptoms2. Utilizing somatic tracking can teach us to respond to our symptoms with lightness, ease, calmness, and compassion. By changing our emotional response to the symptoms, it can result in our symptoms reducing or becoming eliminated2. Our therapists are experienced in teaching somatic tracking and making it individualized for each client.

Here is a free somatic tracking practice to try:


Graded Exposure to What You Fear

Our natural response to chronic pain or symptoms is to start avoiding anything and everything that could be triggering our symptoms, which can include: certain movements, positions, activities, environments, foods, sounds, or time of day. This causes us to enter into a symptom-avoidance cycle where our symptoms cause us to avoid, the avoidance causes our brain to feel more in danger which triggers more symptoms, more symptoms cause more avoidance, and more avoidance causes more symptoms. We have seen clients stuck in this cycle for decades.

It often isn’t the condition that is triggering our pain or symptoms, but the fact that the brain has learnt to view the condition as dangerous2. Essentially the brain has made a mistaken association between the condition and the symptom. Healing chronic pain and symptoms involves slowly, gently, and compassionately approaching conditions we fear while using somatic tracking to create safety. Approaching these conditions can be REALLY SCARY, however, it supports our brain in breaking these mistaken associations2. This can allow us to live more fully with less pain or symptoms!


Leaning into Pleasant Sensations

When we experience chronic pain or symptoms we get really good at hyper-focusing on unpleasant sensations in our body. Part of retraining our brain is teaching it to focus on pleasant sensations. Consistent practice of leaning into pleasant sensations cultivates nervous system regulation and supports the brain in more easily gravitating towards these sensations in the future2. Leaning into pleasant sensations could look like:

  • Feeling the warmth of the sun on your skin
  • Feeling the pleasant sensations of breathing slowly
  • Noticing loose or relaxed sensations in your body
  • Attending to sights or sounds that are calming
  • Enjoying a warm coffee or tea
  • Using soothing touch (making circles on your chest or giving yourself a hug)


Conclusion

As you can see there are many ways we can utilize PRT to retrain our brain out of chronic pain or symptoms. If physical treatments have provided limited results in healing your symptoms, it may be time to start focusing on treating the brain.


If you need support with your healing book in for a free 20-minute consultation with one of our therapists.

  1. Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: time to back off?. Journal of the American Board of Family Medicine : JABFM, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102

  2. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training. 

  3. Gordon, A., & Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  4. Woolf C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

  5. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669

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