Science and Resources
This page summarises the current scientific research on neuroplastic (or “nociplastic”) pain and symptoms, Pain Reprocessing Therapy (PRT), and related mindbody approaches. Sign up to my newsletter to be notified about new findings.
At the bottom of the page, you can find a list of books, podcasts, and other resources for learning more.
The science
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Pain can occur without tissue damage.
In 2020, the International Association for the Study of Pain (IASP) revised its definition of pain to acknowledge that pain can occur without tissue damage, and that it is influenced by biological, psychological, and social factors.
Raja SN et al. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 161(9): 1976–1982.
Read the research: Pain can occur without tissue damage. (opens in a new tab)Structural findings don’t always cause pain.
A systematic review of 33 studies covering 3,110 people without back pain found disc degeneration on spinal imaging in 37% of 20-year-olds and 96% of 80-year-olds, and disc bulges in 30% and 84% respectively. The authors conclude that: “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
Brinjikji W et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology 36(4): 811–816.
Read the research: Structural findings don’t always cause pain. (opens in a new tab)The brain changes as pain becomes chronic.
A study of 40 people with recent-onset back pain who were scanned repeatedly over a year. The strength of communication between the medial prefrontal cortex and the nucleus accumbens (regions involved in emotion and motivation) predicted with 85% accuracy who would go on to develop chronic pain.
Baliki MN et al. (2012). Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience 15(8): 1117–1119.
Read the research: The brain changes as pain becomes chronic. (opens in a new tab)Chronic pain is associated with emotional brain circuits.
The study found that as pain became chronic, its representation in the brain shifted from regions associated with acute pain towards emotional circuits.
Hashmi JA et al. (2013). Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain 136(9): 2751–2768.
Read the research: Chronic pain is associated with emotional brain circuits. (opens in a new tab)Nociplastic pain requires a different treatment approach.
Nociplastic pain (where pain is more widespread and/or intense than would be expected given the amount of identifiable tissue or nerve damage) is associated with other central nervous system derived symptoms, such as fatigue, sleep, memory, and mood problems and is considered a central mechanism in conditions such as fibromyalgia and IBS. This kind of pain has decreased responsiveness to therapies such as anti-inflammatory drugs and opioids, surgery, or injections, necessitating a different approach.
Fitzcharles M-A et al. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet 397(10289): 2098–2110.
Read the research: Nociplastic pain requires a different treatment approach. (opens in a new tab)The brain amplifies pain in fibromyalgia.
A functional MRI study of 16 people with fibromyalgia and 16 people without found that mild pressure produced pain and activity in pain-processing regions of the brain in people with fibromyalgia but not in the comparison group. People without fibromyalgia needed stronger pressure to feel the same level of pain.
Gracely RH et al. (2002). Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis & Rheumatism 46(5): 1333–1343.
Read the research: The brain amplifies pain in fibromyalgia. (opens in a new tab)Heightened sensory sensitivity predicts pelvic pain.
A study of 200 women of reproductive age measured their sensitivity to light, sound, pressure, temperature, and bladder filling, and then tracked their pelvic pain for four years. Heightened sensitivity across these senses became an increasingly strong predictor of pelvic pain over time.
Kmiecik MJ et al. (2023). Multimodal hypersensitivity derived from quantitative sensory testing predicts pelvic pain outcome: an observational cohort study. Pain 164(9): 2070–2083.
Read the research: Heightened sensory sensitivity predicts pelvic pain. (opens in a new tab)Sensitivity to light predicts who won’t get pain relief from surgery.
A study of 243 people found that those with chronic pain conditions rated flashing lights as significantly brighter than people without pain did. Among the 68 people who had surgery for their pain (hip replacement or hysterectomy), those who rated the lights as brighter beforehand were less likely to have their pain reduced by at least half six months later.
Waller N et al. (2025). Visual hypersensitivity as a transdiagnostic marker of surgical pain response in arthritis and chronic pain syndromes. Arthritis & Rheumatology (online ahead of print).
Read the research: Sensitivity to light predicts who won’t get pain relief from surgery. (opens in a new tab)Pain Reprocessing Therapy (PRT) may provide substantial and durable pain relief for people with chronic back pain.
In the Boulder Back Pain study, 151 adults with chronic back pain were randomly assigned to PRT, placebo, or usual care groups. After treatment, 66% of the PRT group were pain-free or nearly pain-free, compared with 20% of the placebo group and 10% of the usual-care group. The differences were largely maintained after one year.
Ashar YK et al. (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.
Read the research: Pain Reprocessing Therapy (PRT) may provide substantial and durable pain relief for people with chronic back pain. (opens in a new tab)Changing beliefs about pain predicts pain reduction.
An analysis of the Boulder Back Pain study found that before treatment, only 10% of the reasons participants gave for their pain referred to the mind or brain. After PRT, 51% did, compared with 8% in the comparison groups. The more participants came to understand their pain as a product of mind–brain processes, the greater their reduction in pain.
Ashar YK et al. (2023). Reattribution to mind-brain processes and recovery from chronic back pain: a secondary analysis of a randomized clinical trial. JAMA Network Open 6(9): e2333846.
Read the research: Changing beliefs about pain predicts pain reduction. (opens in a new tab)PRT results last longer than placebo or usual care.
A five-year follow-up of the Boulder Back Pain study found that pain was still lower in the PRT group than in the comparison groups, although the difference was smaller than immediately after treatment. Participants who had received PRT were also less afraid of movement and more likely to attribute their pain to mind–brain processes.
Ashar YK et al. (2025). 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 82(10): 1049–1051.
Read the research: PRT results last longer than placebo or usual care. (opens in a new tab)PRT shows promising preliminary results for fibromyalgia.
35 adults with fibromyalgia received three sessions of brief PRT by video. Pain intensity, pain interference, and pain-related fear decreased over three months, and 42% of those who completed the study rated themselves much or very much improved. The study had no control group, so these results are preliminary.
Sturgeon J et al. (2025). Brief pain reprocessing therapy for fibromyalgia: a feasibility, acceptability, and preliminary efficacy pilot. Regional Anesthesia & Pain Medicine (online ahead of print).
Read the research: PRT shows promising preliminary results for fibromyalgia. (opens in a new tab)PRT for migraine: a case series.
Three people with chronic migraine, who had not responded well to standard preventive and acute treatments and also had other pain conditions, were treated with PRT. Their headache or migraine days fell from 18–25 to 3, from 30 to 5, and from 30 to 3–4 per month, and they reported improvements in their other pain conditions. With only three patients and no comparison group, the authors call for controlled studies.
Fishbein JN et al. (2025). Pain Reprocessing Therapy for migraine: a case series. Headache 65(9): 1660–1665.
Read the research: PRT for migraine: a case series. (opens in a new tab)
Resources
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Alan Gordon & Alon Ziv, The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain (2022)
The book on Pain Reprocessing Therapy by its developer, Alan Gordon.
Howard Schubiner, Unlearn Your Pain: The Science of Recovering from Chronic Pain, Fatigue, Anxiety, and Depression (2026)
Schubiner is a medical doctor, Clinical Professor, and co-developer of Emotional Awareness and Expression Therapy (EAET). The book gives a solid introduction to the science and effective approaches.
John E. Sarno, Healing Back Pain: The Mind-Body Connection (1991)
From the originator of mind-body medicine.
Nicole Sachs, Mind Your Body: A Revolutionary Program to Release Chronic Pain and Anxiety (2025)
On emotional expression and chronic pain.
Tell Me About Your Pain
A 15-episode series in which Alan Gordon and Alon Ziv respond to people living with chronic pain and demonstrate PRT techniques such as somatic tracking.
Pain Reprocessing Therapy Podcast
From the Pain Reprocessing Therapy Center: live therapy sessions and conversations with PRT clinicians and researchers.
Like Mind, Like Body
Curable’s podcast, with interviews with researchers, clinicians, and people who have recovered from chronic symptoms.
Muss das so wehtun?
A German-language podcast on mindbody approaches to chronic pain and symptoms.
All the Rage (2016)
Documentary about John Sarno’s work, directed by Michael Galinsky, Suki Hawley and David Beilinson.
This Might Hurt
Documentary (directed by Marion Cunningham and Kent Bassett) following three people through a mindbody pain programme run by Howard Schubiner.
Pain Reprocessing Therapy Center
Information on PRT and a directory of trained practitioners.
Association for the Treatment of Neuroplastic Symptoms (ATNS)
Education and a directory of mindbody practitioners.
TMS Wiki
Community-run site with free educational programmes and recovery stories.
Curable
Self-guided app based on pain science and brain-retraining techniques (subscription necessary).
“The mindbody revolution: how the division between mental and physical illness fails us all” (The Guardian, 2025)
Argues that the mental/physical divide in Western medicine is scientifically untenable and harms patients, especially those with conditions like functional neurological disorder and chronic pain.
“Pain Reprocessing Therapy: Achtsamer Umgang mit Schmerzen” (Deutschlandfunk Nova, 2026)
Main Huong Nguyen gives an overview of the current state of research. In German.
Mind-Body Ressourcen
A German-language collection of resources to support people affected by chronic pain and symptoms, and professionals.