At Embodied Physiotherapy and Pilates, we often see people who have lived with pain longer than they expected. Sometimes they’ve tried everything conventional, from manual therapy to imaging to exercise programs, but pain persists. That can feel frustrating, defeating, or even frightening. Pain Reprocessing Therapy (PRT) introduces a new way of understanding chronic pain based on current neuroscience. It draws on principles from psychology to help people shift how pain is processed in the brain—using techniques that can be integrated into movement and rehabilitation without requiring formal psychological treatment.
Understanding Chronic Pain
When pain lasts longer than three months, it moves into the category of chronic pain. In most cases, tissue heals from injury in that three-month window, so when pain continues past that point, we need to consider changes in how the nervous system is processing danger and safety.
Pain can be thought of like the body’s alarm system. When we’re injured, the alarm goes off to alert us to the danger so we can take action and address the issue. But sometimes, even after the body has healed, the alarm keeps ringing.
Pain becomes less about tissue damage and more about the nervous system getting stuck in a state of high alert. Past experiences, emotional stress, fear of reinjury, and even helpful protective traits (like powering through or trying to “fix” things) can keep the brain convinced that it’s still under threat. This is why chronic pain is often described as a whole-person experience, not just a physical one.
How Pain Works (and How It Can Change)
All pain comes from the brain. That doesn’t mean it’s imagined or not real—far from it. Pain is very real. But pain originates in how the brain interprets signals, not just in the tissues. When we understand that the brain sometimes misreads those signals, we can begin to shift them.
PRT focuses on helping people understand their pain and respond differently, which can lower the threat level and start to turn the volume down on the alarm. This includes learning about the pain-fear cycle: the more afraid we are of pain, the more sensitive the nervous system becomes, which leads to more pain, which leads to more fear. And so on.
By helping people identify the “flavours” of fear they carry—whether it’s anxiety, frustration, self-judgment, or uncertainty—we can start to ease the brain’s sense of threat. Simply noticing fear as it arises and naming it with curiosity (“Oh, hi fear, I see you”) begins to shift the pattern.
PRT Techniques for Addressing Chronic Pain
Pain Reprocessing Therapy offers an approach with five main components. The first is education about how the brain works in relation to pain. Understanding how the brain gets caught in the pain-fear cycle allows a shift in perspective towards safety.
Second is gathering personalized evidence for the brain’s neuroplastic relationship with pain. Upon reflection there are often examples where pain did not behave as expected, or where circumstances or environments elicited different responses, and this can help to conceptualize pain as neuroplastic (brain-generated) as opposed to structural (muscle/ligaments/discs/bones).
Third is the practice of attending to pain sensations through a lens of safety, primarily using a technique called somatic tracking. When we take the time to attune to our bodies and become more familiar with the sensations we’re experiencing, we increase safety and reduce fear.
The fourth component takes a look at other emotional threats that are present from a whole-person perspective including protective traits, coping strategies and personal history as applicable. This rounds out the view and allows a look at all contributing factors.
And lastly, we spend time gravitating towards finding positive feelings and sensations in the body. Pain can become a broad brushstroke over the sensation experience, and reorienting to safety means building up the capacity for feeling and perceiving positive sensations in the body.
Movement as a Tool for Rewiring
Because the nervous system is neuroplastic—meaning it can be reshaped—we can create new, safer patterns through experience. Movement is one of the most powerful ways to do this. In our Pilates-based rehab sessions, we use movement not to “fix” the body, but to explore what it’s like to move without fear, with support, and with attention.
Each time a person has a neutral or positive movement experience where pain does not equal danger, a new pathway is formed in the brain. The more we travel and practice that pathway, the stronger it becomes. The goal isn’t perfection—it’s repetition, with awareness and safety.
The Role of the Nervous System
Our nervous system is constantly listening to what’s happening inside and around us. When it’s overprotective—due to trauma, stress, or long-standing pain—it starts interpreting neutral signals as dangerous. This is why people with chronic pain might feel pain from gentle movement, or experience fatigue from small tasks. Their systems are doing their best to protect them—but their systems are doing too much.
A PRT approach helps tone the “Relaxed” state of the nervous system, especially through breath, safe connection, and gentle, attentive movement. We work toward helping clients shift from shutdown or fight/flight mode into play, curiosity, and trust—even if just for a few moments at a time. That shift is where healing starts.
Protective Traits and the Pain-Fear Cycle
Many people living with chronic pain have developed patterns that once protected them but now contribute to ongoing sensitization. These protective traits include perfectionism, powering through, people-pleasing, avoidance, rumination, and more. We don’t try to get rid of these traits—we learn to notice them, acknowledge their role, and gently bring them back into balance so they are not overpowering our experience and signaling ongoing danger to the alarm system.
PRT doesn’t rely on willpower or force. It relies on awareness, repetition, and self-compassion. And that can be surprisingly powerful.
Who Can Benefit
PRT is especially helpful for:
- Persons who are experiencing pain after injury beyond the normal course of healing (3 months)
- Persons whose pain isn’t explained by injury or structural damage
- Persons for whom conventional treatments have been unsuccessful
- Persons who recognize a strong psychological component to their pain
- Persons who have undiagnosed pain despite multiple tests and treatments
Pain can change—and there are tools to help support that process.
Disclaimer:
We’re not psychologists, and we don’t offer psychological therapy. What we do is borrow some of the principles behind Pain Reprocessing Therapy and apply them through movement, education, and the work we do in our sessions. These tools come from a growing understanding of how the brain and nervous system contribute to chronic pain—and we integrate that understanding in a way that fits within our scope as physiotherapists and movement professionals. When more specific mental health support is needed, we refer to trusted registered clinical counsellors and psychologists as part of a collaborative care approach.