Can Pain Reprocessing Therapy Cure Chronic Pain?

Photo by Karolina Grabowska
Sixty-two-year-old Nancy Bruskin had been practising yoga for 40 years and working as a yoga instructor for over 20 of those years when, one day, she developed crippling back pain that altered her life completely. 
She was in constant pain, couldn’t bend down and couldn’t sit up from a lying down position. As someone who had spent 40 years dedicated to exercise and movement, the sudden pain was a devastating blow.
"The pain had a hugely significant impact on my life," Bruskin tells Refinery29. "I started seeing every doctor and specialist I could think of but no one could help me."
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"I couldn’t move at all without having that permanent look on my face – the one that screams, Holy cow, I am in so much pain," she says. 
After six years of seeing doctor after doctor and finding no one who could help relieve her pain, Bruskin came across an advertisement for a study that was being conducted in her hometown of Boulder, Colorado, by a man named Alan Gordon – a man she now says changed her life.
The study began with an MRI scan of her back and then multiple sessions with Gordon. Entering her first session, Bruskin was expecting him to examine her physically, perhaps get her to do exercises.
"But we just talked," she tells me, "and I said: 'Is this therapy? I thought you were going to fix my back?'"
"Alan said: 'Well yes, it is therapy, and the idea is that it is going to fix your back.'"
Gordon took Bruskin through a series of meditations during which he encouraged her to sit with her pain, notice it and acknowledge it without judgement.
"He asked me to put my hand on my chest and say to myself: 'The sensation I’m experiencing is temporary, I am okay, I am safe.'"
Bruskin tells me that she immediately struggled to say the words 'I am safe' because she didn’t feel it. 
"I thought to myself, How interesting, because of course I’m safe: I have a roof over my head and food in my refrigerator. But still my body felt like I was in danger."
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If a person has chronic neuroplastic pain, it means that somewhere along the way, their relationship with danger and fear has become overactive.

alan gordon
This concept of re-engineering a sense of safety around pain that has been activating the body’s fight-or-flight response for so many years is at the core of Gordon’s new treatment, called pain reprocessing therapy, which he believes can completely cure some patients of their chronic pain.
Gordon was in graduate school when his own pain began. It came out of nowhere and it wouldn’t go away. His back pain became so severe that he couldn’t tolerate sitting in the chairs at his university and ended up wheeling his own office chair around campus, from class to class, just to keep him from dropping out of his degree.
Gordon was studying psychology and soon became interested in the brain’s involvement with pain signals. All pain, in truth, is created in the brain – it is a product of the brain interpreting physical sensations as dangerous.
When the body is injured, the brain and nervous system alert us, using a pain sensation, in order to protect us from further injury. But as researchers have learned more about how the brain and nervous system send pain signals, they have realised that sometimes the brain gets it wrong. As with any medical problem, the brain’s neural pathways can simply stop working as they should and start sending erroneous pain signals. This can happen when a person is injured and recovers but the brain mistakenly continues sending pain signals. It can even happen when there is no original injury at all.
Gordon decided to conduct an experiment to test whether the psychological process he had developed for unlearning pain could work for others. He set up a clinical trial in Boulder during which he would take chronic pain patients through this process, called pain reprocessing therapy, or PRT. 
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PRT, Gordon says, can help to relieve the symptoms of what he calls neuroplastic pain. This is a subset of chronic pain that is not caused by tissue damage in the body but rather by erroneous neural signals that tell the brain there is danger or injury when there is not.
PRT aims to replicate and systematise the way that Gordon taught his brain to unlearn pain. For the study, Gordon and his team took patients through multiple sessions of PRT, each of which is designed to teach the patient about the role of neural pathways in creating pain and to explain how their brain can misinterpret ordinary signals as dangerous. 
During PRT sessions, Gordon teaches patients to pay close attention to their pain, describe it and assess it. This teaches the brain not to be afraid of it and to calm down the overactive alarm systems.
"If a person has chronic neuroplastic pain, it means that somewhere along the way, their relationship with danger and fear has become overactive," Gordon explains. Pain, he says, is all about perception of danger. It’s part of our threat response, or our fight-or-flight response. PRT is about calming down that threat response, he says.

The brain interprets tissue damage and misfired pain signals exactly the same way. It does not matter which type of pain it is, it feels the same, and it is all equally real and equally valid.

alan gordon
Gordon conducted constant neuroimaging of the patients’ brains using MRI scans throughout the treatment. They showed that the patients’ brains were in fact firing fewer pain signals when pain was purposefully inflicted on them during the scan.
"Pain is the brain’s interpretation of tissue damage in the body," he explains to me. "It is your brain making an assessment of what is going on in the body and trying to send you warning signs."
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"But the thing is, it doesn’t always get it right. It doesn’t always provide a perfectly accurate representation of what’s going on in your body."
Remarkably, 66% of patients who undertook the Boulder trial were pain-free or nearly pain-free by the end of the study, compared with 20% of the placebo group and 10% of the control group.
Bruskin is among that 66%. Since participating in Gordon’s study she has not had a single episode of back pain. She has been completely pain-free for five years.
"It completely changed my life," she tells me. "I can now pick up my granddaughter and play with her: things I could never have imagined doing when I was in pain."
On a regular Saturday in Boulder, Dan Waldrip was mowing his lawn while his wife played with his young daughter inside. He had just finished graduate school and started his first big job. Until this particular day, Dan had never experienced any serious medical problems. He played basketball and golf, went running and loved home improvements. But something happened that day while he was mowing the lawn – at least that’s what he thought when he woke up the next morning with crippling back pain that didn’t go away for 18 years. 
"When I opened my eyes that morning, I felt a pain in my back that I’d never felt before," Dan tells me. "It was crippling."
"By Monday I couldn’t function at all."
Dan’s back stayed this way for almost two decades. It would get better and it would get worse, he explains, but the pain never went away. Some days he struggled to put socks on. Other days, sitting on a chair felt like torture. He was never able to be active and couldn’t do any of the things he loved. Even the bare minimum of physical activity caused extreme pain. 
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"When I realised it was never going to go away, I decided I just needed to keep living as best I could and just pay the price," he tells me. "I would play golf for an hour, knowing I wouldn’t be able to walk for days afterwards. I just decided I didn’t want to surrender everything to the pain."
Dan explored the idea of corrective surgery to fix his injured back but the results of those kinds of surgeries were often hit and miss. 
"I decided I would just live with my pain until the surgery technology improved," he tells me. 
Dan also lost his faith in doctors. He had tried everything and nothing had worked.
"But I don’t blame them," he says. "They were sympathetic – but they just couldn’t help me."
When he says this I think about the podcast Dr Death, which brought into the popular consciousness the crimes of Dr Christopher Duntsch, a surgeon who preyed on patients with chronic back pain and convinced them to allow him to perform dangerous surgeries that left them paralysed and, in some cases, dead. Duntsch has since been imprisoned for life for the crimes he committed against vulnerable and desperate pain patients but back when Dan was considering surgery, he was still practising and only a few states away. This could have been a very different kind of interview, I think to myself. 
One day, Dan was dropping off his now-grown daughter at swimming practice and picked up a leaflet advertising Gordon's PRT study. He signed up immediately. 
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Dan says he has been completely pain-free since he completed the PRT sessions.
"I haven’t had pain in my back for five years," he tells me. "This treatment is the closest thing I’ve ever experienced to a miracle."
"I live a totally normal life. I help people move house, I golf, I do home improvements – all without pain."
Another thing that Dan says helped to rewire his neuroplastic pain is when Gordon encouraged him to pinpoint the moments over the last 18 years when the pain and symptoms were most severe, and to explain what was going on in his life at that time.
"I’ve always been so stoic, always felt like I have to pretend everything’s fine," he says.
"But when I look back, my pain was always the worst when I was experiencing extreme stress or big life changes."
"I don’t wear stress outwardly so mine went inward," he says. "The pain was my brain trying to alert me that something was wrong."
Dan says that understanding his pain in this way has meant that as part of his recovery he is determined to stop suppressing feelings of stress and anxiety, lest they trigger his pain.
"These days I’m much more willing to say: 'Yes, this is hard,'" he tells me. "I think that really frees up my brain and stops it from always trying to protect me. My body and my brain have finally teamed up and I’m so much happier."
As for me, I have a vested interest in this subject. I have lived with debilitating chronic pain since I was 17.
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I have since been diagnosed with endometriosis and Crohn’s disease, two immunological conditions that cause persistent abdominal pain. This means that my specific kind of pain does not fall into the purely neuroplastic category because there is structural damage in my body that needs attending to. But I also believe that it’s possible that my neuroplasticity has learned to amplify pain signals because I have lived with under-treated pain for so long. It’s possible that these techniques can help those with physical damage as well as those for whom any injury or structural damage has been resolved but the pain persists. 
I spent a lot of time in my teens and 20s chasing a diagnosis for my pain. I was told again and again that the pain was psychosomatic, that it was 'all in my head'. I was forced to fight against medical prejudice and gaslighting so I know how damaging it is when your pain is dismissed.
So I know what you’re thinking: Is Gordon’s approach just another way of casting some pain as imaginary?
I put this to Gordon and I can tell he gets it a lot.
"All pain is absolutely real," Gordon tells me. "Absolutely, absolutely real. There is no such thing as imaginary pain."
"The brain interprets tissue damage and misfired pain signals exactly the same way," he says. "It does not matter which type of pain it is, it feels the same, and it is all equally real and equally valid."
I can tell that Gordon feels strongly about this. He knows what it’s like to have your pain dismissed as unimportant or unembodied – it happened to him for years. To say that pain is neuroplastic is not to say that it is not real, he says.
So I think it’s important to say here that treating the neural aspects of pain, using neuroscientific research, is not the same as saying that pain is imagined or is a psychological symptom. It is simply a different way of understanding the very real cause of the pain, which for some people is a problem with the nervous system, the brain and the spine rather than the part of the body that is in pain.
As someone who, like Dan, knows what it’s like to struggle to put socks on, I’m willing to give it a go.

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