Imagine living with chronic pain for years, feeling like there’s no escape. Now imagine understanding why your pain persists – and discovering you have the power to change it. Pain Reprocessing Therapy (PRT) is a groundbreaking approach that does just that, teaching the brain to unlearn pain. To guide you on this journey, we’ve created a glossary of essential PRT terms so you can better understand and embrace the science behind pain relief.
Acute Pain
Pain due to various physical/ structural issues (injury, fever, infection, etc.) lasting for four weeks or less
Amplification
Increased level of pain due to fear, anxiety, hypervigilance, preoccupation, or any psychological danger signal or perception of threat.
Avoidance Behavior
Action taken to escape from/ get rid of pain.
External: Changing physical position/ engaging in physical activity to reduce the pain.
Internal: Shifting attention away from a painful sensation to another sensation (i.e., the breath).
Bottom-Up Processing
The process in which sensory receptors receive input from the external environment and send it to the brain for perception.
Behavioral Exposure
Resuming life activities with guidance on reframing the pain, communicating messages of safety, and focusing on positive sensations/ non-pain goals.
Chronic Pain
Pain that persists long after an injury has healed/ after the normal course of healing (usually over 3 months) despite medication/ treatment.
Primary: No underlying condition adequately accounts for the pain; the pain is the primary problem.
Secondary: An underlying condition accounts for the pain; the pain is secondary to this condition.
Conditioned Response
The brain creates associations between specific activities and adverse outcomes to protect us from repeating dangerous behaviors.
Corrective Experience
Exposure to a fear-inducing stimulus resulting in a reduction of fear.
Danger Signal
When the brain reacts to a perceived threat for the purpose of survival.
Anxiety: A fear/ worry in anticipation of a perceived threat in the external environment. Evolutionarily, this danger signal helps us fight harder or escape quickly (fight or flight).
Depression: A feeling associated with a loss of energy, motivation, and hope. Evolutionarily, this danger signal helps us reserve resources necessary for survival/ encourages the enemy to leave us alone (freeze).
Fatigue: A feeling of low energy and a strong desire to sleep that interferes with daily activities. This danger signal warns us that our system needs to rest and recover.
Itchiness: A feeling that causes scratching or rubbing to defend against bugs or parasites on the skin.
Nausea: A feeling that prevents us from continuing to eat something dangerous
Delayed Onset
Experiencing pain only after completing an activity, but not during it.
Empowerment
The ability to view pain as an opportunity to achieve a corrective experience to neutralize fear.
Evidence (Gathering and Reinforcing)
Gathering counter-evidence to reinforce that pain is due to central processes and not structural problems in the body.
Experiential Evidence: Engaging in activities/ somatic tracking resulting in a reduction in pain, reinforcing a neuroplastic diagnosis.
Extinction Burst
A phenomenon resulting in a spike of intense pain just after fear and symptoms decrease.
“Failed Back Surgery Syndrome”
A common phenomenon where patients experience continued back pain after spinal surgery.
Fear
A feeling induced by a perceived danger that heightens alertness, sensitivity, and the desire to escape.
High Alert/ Hypervigilance
An elevated state of constantly scanning the environment for danger/ potential threats. Being in a state of high alert may contribute to the misinterpretation of neutral stimuli.
Mindfulness
The awareness that emerges through paying attention intentionally, in the present moment, and without judgment.
Mixed Pain
A combination of neuroplastic and physically-caused pain.
Negative Behavioral Patterns
The tendency to engage in familiar abusive/ neglectful patterns that activate danger signals.
Neural Pathways
A series of connected neurons that send signals to one another. Neural pathways are responsible for helping us learn new behaviors and activities that are stored in learned memory.
Neuropathic Pain
Pain that is generated because of damage to nerves.
Neuroplastic Pain
Pain that persists after an injury has healed or has no apparent physical cause. Neuroplastic pain is caused by the brain misinterpreting safe messages from the body as if they were dangerous. But, when the brain learns and changes in response to pain, it can become chronic. “Neuro” refers to the brain and other parts of the nervous system. “Plastic” means developed or changed. Other names for neuroplastic pain include:
Central Sensitization: A condition where the central nervous system learns to be overly sensitive to non-threatening stimuli.
Mindbody Syndrome
Nociplastic Pain
Psychophysiologic Disorder (PPD)
Tension Myositis Syndrome (TMS): A name given by John Sarno to a condition of psychogenic musculoskeletal and nerve symptoms
Neuroplasticity
The brain’s ability to learn and change.
Neutral Sensations
Paying attention to sensations that aren’t painful or pleasant, but simply neutral. For some, it may be easier to attend to a neutral feeling rather than one with a history of fear. This can also be used if patients have difficulty finding a pleasant sensation.
Nociceptive Pain
Pain that is generated because of damage to body tissue.
Nociceptors
Specialized peripheral sensory receptors that detect painful stimuli.
“Normal Abnormalities”
The idea that even “abnormal” findings on an MRI often don’t line up with physical symptoms and are typically “normal” signs of aging or wear/ tear to the body.
Outcome Independence
When the patient’s emotional state is no longer dependent on their pain level.
Pain
Your brain’s response to danger signals sent by sensory receptors in the body. We experience pain to protect us from causing further tissue damage.
Pain Beliefs
Represent a patient’s conceptualizations of pain and what pain means for them.
Pain-Fear Cycle
Pain triggers feelings of fear. Fear makes the brain more likely to misinterpret safe signals as dangerous, which causes more pain. More pain leads to more fear. More fear leads to more pain.
Pain Reprocessing Therapy (PRT)
A system of psychological techniques that retrains the brain to interpret and respond appropriately to signals from the body, breaking the cycle of chronic pain.
Pivot
Adjusting to your patient’s reactions during a somatic tracking exercise.
Placebo
A group/subset often used in research studies designed to deceive participants into thinking they are receiving treatment/medication when they are not.
Placebo Effect
The beneficial impact/ improvement in health from taking a placebo, mainly due to the patient’s belief that the drug is real.
Positive Affect Induction
Anything that helps break the intensity/ lighten the mood during somatic tracking so that patients can attend to sensations through a lens of safety (humor, stories, positive memories, analogies).
Positive Feedback Loop
Occurs when the product of a reaction leads to an increase in that reaction. With pain, when the response to the symptoms includes fear, the patient will be more fearful in the future.
Positive Sensations
Focusing on pleasant feelings instead of pain.
“The Process”
A set of strategies aimed at maximizing corrective experiences and minimizing retraumatization to gradually overcome pain.
Psychoeducation
Educating patients on how pain can develop and persist and the importance of breaking the pain-fear cycle. The first step in PRT treatment.
Anecdotal: Using patient examples (typically to normalize, validate and instill hope).
General: Providing information, data, and research.
Personal: Shares personal experience with neuroplastic pain (typically to normalize, validate, build rapport, and instill hope).
Prefrontal Cortex
Part of the brain responsible for learning and making meaning. With chronic pain, there is increased activity in this area of the brain.
Preoccupation
The tendency to run toward a familiar physical feeling. Patients often run away from an unfamiliar/uncomfortable physical sensation associated with stillness.
Reinforcement
The reaction to a feared stimulus that either encourages the brain to interpret it as dangerous or safe in the future.
Relapse
When the pain returns because of an injury, perceived injury, stressful event, or because the patient falls back into old negative behavioral patterns.
Retraumatization
Exposure to a fear-inducing stimulus resulting in an increase in fear.
Safety Reappraisal
Any message that can help a patient feel safe, specifically during a somatic tracking exercise.
Secondary Gain
When a patient benefits from their pain symptoms in some way, decreasing their motivation to get better.
Self-Compassion
The communication of authentic feelings of love, care, and safety to one’s self.
Setback
An “off day” or week. Having a setback may be an opportunity to build resilience, ultimately leading to a reduction in fear and a greater capacity to recover.
Shame
A learned feeling of humiliation and self-loathing that is not necessarily related to a specific behavior/ event.
Somatic Tracking
A technique to retrain the brain to correctly interpret signals from the body by attending to a painful sensation through a lens of safety, thereby deactivating the pain.
Active Somatic Tracking: Patient is engaged in physical movement.
Passive Somatic Tracking: Patient is stationary.
Imaginal Somatic Tracking: Patient imagines doing the activity/movement that brings on pain.
Somatosensory Cortex
A region of the brain responsible for receiving and processing sensory information from the body.
Symmetrical Symptoms: When pain develops in the same part of the body but on opposite sides (i.e. both wrists, both ankles, etc.), it is unlikely that the pain is rooted in physical damage.
Symptom Imperative
When symptoms change location in the body or become replaced by another condition after pain begins to improve in one area. Indicative of remaining underlying fear.
Top-Down Processing
Internal predictions about what a patient expects to feel based on past experiences.
Ulterior Motive
When a specific outcome is desired during somatic tracking, a corrective experience is prevented.
Empowering Your Healing Journey with PRT
PRT provides hope for those living with chronic pain by addressing the root cause: the brain’s misinterpretation of neutral signals. By understanding the key terms in PRT, you can better grasp the science behind the therapy and the mind-body connection that plays a crucial role in healing. This approach encourages breaking old patterns, relearning how to interpret bodily sensations, and shifting the way you experience pain. With continued practice and support, PRT will transform how you respond to pain, empowering you to reclaim your life and move forward with confidence.