Does PRT mean "the pain is fake"?

Not at all. The pain is 100% real — the brain is really firing a "threat" signal. Only the source of the threat is brain learning, not body damage. Sending the patient a "malingering" message is the opposite of PRT.

I've had chronic low back pain for 10 years — is it still possible?

Boulder participants averaged 11 years of pain — yet 66% became pain-free. Longer pain duration means deeper "brain learning", but the "re-learning" effect is correspondingly larger. Note: real disc / nerve damage must be ruled out first.

Where can I get PRT in Korea?

PRT is in early-adoption phase in Korea as of 2024. Some psychiatrists, clinical psychologists, and pain physicians are learning it. Alternatives: 1) Korean edition of Alan Gordon's "The Way Out", 2) integration with mindfulness meditation, 3) pain-neuroscience education, 4) emotion-focused psychotherapy.

Neuroplasticity of chronic pain — "the brain's error, not the body's", Pain Reprocessing Therapy (PRT), Boulder Back Pain Study: 66% pain-free at 8 weeks

80% of chronic pain (3+ months) lacks actual tissue damage and is "central sensitization" — "neuroplastic pain" in which the brain has learned and amplified pain signals. Pain Reprocessing Therapy (PRT) was developed by Howard Schubiner, Alan Gordon, and others. The 2021 JAMA Psychiatry Boulder Back Pain Study (Ashar et al.): 151 chronic-low-back-pain patients, 4 weeks of PRT followed by 8-week tracking — 66% pain-free (control 20%, placebo 10%). In Korea, a significant share of chronic low back pain, headaches, chronic pelvic pain, fibromyalgia, and IBS is presumed to be neuroplastic pain. Core treatment principles: ① relearn pain as "safe" (Pain Reattribution), ② normal imaging = "no danger" message, ③ mindfulness "observation of pain" (non-threat mode), ④ emotional work to "reconcile" with pain. Strong effect for patients who have tried drugs and surgery without success. Note: real tissue damage, cancer, infection, fractures, etc. are NOT for PRT — medical diagnosis comes first.

1. "My tests are normal — why does it hurt?"

About 25% of Koreans — 12.5 million people — have chronic pain (3+ months). Of these, 80% have normal MRI, CT, and blood tests. Even after analgesics, physical therapy, injections, and surgery, the pain persists. Common conclusions: "malingering", "psychological", "lifelong management". Neuroscience offers a different answer: real pain, but "brain, not body".

2. Neuroplastic pain

Pain is not a simple "sensor (body) → signal → brain" model. Pain experience is the result of the brain's "threat appraisal" of the signal. Lorimer Moseley's (University of South Australia) pain neuroscience:

Acute injury (e.g., sprained ankle) → pain circuit activated
The brain maintains "threat learning" even after healing
In the same posture / movement / environment, "pain prediction" → real pain occurs
This is the neuroplastic mechanism of chronic pain

Key: pain = brain's threat appraisal. Actual damage ≠ pain.

3. Boulder Back Pain Study — decisive evidence

Ashar et al. (2021) JAMA Psychiatry. Colorado Boulder + Harvard:

Subjects: 151 chronic-low-back-pain patients (mean 11 years of pain)
3 arms: PRT (n=50), placebo injection (n=51), usual care (n=50)
Intervention: PRT group, 4 weeks, 8 sessions
Results (8-week follow-up):

PRT: 66% pain-free or nearly pain-free
Placebo: 20%
Usual care: 10%

fMRI: PRT group showed reduced activity in pain brain circuits (anterior cingulate, insula)

Effects maintained at 1-year follow-up.

4. PRT's 4 core principles

① Pain Reattribution

Consciously reattribute: "This pain is not body damage but brain threat learning". With each pain episode, self-state "this is safe pain". Only after medical clearance.

② Medical Reassurance

After thorough medical evaluation (MRI, CT, blood work, specialist) passes with "nothing wrong", use the result as "evidence". If the patient doubts the test results and seeks repeat tests, entering PRT is difficult.

③ Somatic Tracking

A variant of mindfulness. Observe pain with curiosity, neither avoiding nor fighting it. Describe location, intensity, texture; maintain a "not a threat" message. 5–15 minutes daily.

④ Emotion work

Much chronic pain is the somatization of anger, fear, sadness. Processing unresolved emotions (family conflict, workplace anger, trauma) directly reduces pain. Journaling, psychotherapy, expressive arts.

5. Common forms of neuroplastic pain

Pain	Neuroplastic likelihood	Note
Nonspecific chronic low back pain	High (80%+)	MRI changes ≠ pain cause
Tension headache	Very high	90% of daily headaches
Migraine	Medium	Partly neurological, partly neuroplastic
Fibromyalgia	Very high	Classic central sensitization
Irritable bowel (IBS)	High	Gut–brain axis learning
Chronic pelvic pain	High	Women, postpartum, post-trauma
TMJ / jaw joint	High	When dental exams are normal
Tinnitus	Medium	Partly auditory, partly neuroplastic

6. When PRT should not apply

Recent trauma / fracture
Cancer (metastatic pain)
Infection (bone, joint)
Autoimmune (rheumatoid, ankylosing spondylitis)
Cardiovascular (angina)
Nerve damage (paralysis from disc compression)

These need medical treatment first. PRT applies to "medically unexplained pain".

7. Self-administered 8-week protocol

Week 1: Medical evaluation

Comprehensive evaluation at orthopedics, neurology, pain medicine
Rule out dangerous conditions with MRI / blood work
Get a clear "nothing wrong" result

Week 2: Pain education

Watch Lorimer Moseley "Pain Explained" videos
Read Alan Gordon "The Way Out"
Learn the pain = threat appraisal concept

Weeks 3–4: Pain reattribution

State "this is safe pain" out loud to yourself with each episode
Calm fear / anxiety with breathing
Pain journal — "today's pain + situation + emotion"

Weeks 5–6: Somatic tracking

Daily 10-min "pain observation" meditation
Gradually reduce avoidance and immediate medication
Gradually re-expose to previously avoided activities (walking, sitting)

Weeks 7–8: Emotion work

Journaling and expression of unresolved emotions
Conversations about family / relationship conflicts
If needed, psychiatry / psychotherapy (emotion-focused)

8. Korean resources

University-hospital pain clinics: comprehensive evaluation
Korean Pain Society certified physicians
PRT Korean materials: some psychiatry / psychologists are adopting
Mindfulness meditation centers: somatic-tracking practice
With severe depression or suicidal thoughts: 1577-0199

9. Relationship to medication and surgery

PRT does not replace drugs or surgery — they go together. As PRT works, drug use naturally falls and surgical needs decline. But never stop medication alone — always under a doctor's guidance.