Pain Reprocessing Therapy (PRT): what is it, and what does the research say?

Pain that lasts for more than three months is regarded as chronic. Chronic pain can lead to less activity, which in turn can reinforce the pain, and it can affect sleep and mood [1].

Nociplastic pain is caused by altered pain perception. No specific tissue or nerve damage explains it, and it can be linked to changes in how the nervous system and the immune system work. The pain can be amplified and widespread. Psychological, social and cultural factors can affect the experience of pain [1].

PRT is a psychological treatment developed for long-lasting pain where there is no peripheral tissue cause that explains the pain. The patient learns to understand the pain as a signal from the brain and nervous system that does not necessarily correspond to damage in the body [2]. The aim is to change the perception of the cause and threat of the pain, reduce fear and avoidance, and manage stressors that are not related to the pain itself [3].

Peder Aakvåg is treatment coordinator for the PRT service at Dr.Dropin, and PRT is used for long-lasting pain conditions [4].

The most widely discussed study is a randomised trial from 2022 with 151 adults who had long-lasting back pain without demonstrated peripheral cause. The mean age was 41 years, and the pain had lasted for about ten years on average [2].

The participants were divided into three groups. One group received PRT, one received an open-label placebo injection in the back where they were told it was placebo, and one continued with their usual care. PRT consisted of a conversation with a doctor and eight sessions with a therapist over four weeks [2].

At the end of treatment, 66 percent in the PRT group reported being pain-free or almost pain-free. In the placebo group the figure was 20 percent, and in the usual care group 10 percent [2]. One year after treatment the differences were largely still present [2].

The authors also found that a change in the belief that pain means damage could explain part of the difference. Brain scans showed different activity in several areas between the groups, but these are associations and do not say anything certain about cause [2].

In 2025, results from a five-year follow-up were published. 113 of the original 151 participants took part. Pain intensity was lower in the PRT group than in the placebo group and the usual care group, and 55 percent in the PRT group were pain-free or almost pain-free, compared with 26 percent in the placebo group and 36 percent in the usual care group [3].

The authors conclude that PRT can give lasting improvement for some patients [3]. Note that not all outcomes showed a difference. For example, there was no clear difference between the groups in sleep and anxiety [3].

The study was carried out at one centre in Colorado and had a relatively small sample. The participants knew which treatment they received, which can affect expectations and responses. Several of the authors have ties to the development of PRT [2][3].

The pain in the study was of low to moderate severity, and the authors point out that studies of patients with more severe problems are needed. A quarter of the participants had no data after five years [3]. The studies also concern long-lasting back pain. What PRT means for other pain conditions cannot be read from these results.

The participants in the study had been assessed so that no peripheral cause of the pain had been found [2]. If you have new, changed or unexplained pain, you should therefore have it assessed by a doctor or other healthcare professional before you consider PRT.

If you have had pain over a longer period, a physiotherapist can go through your pain history, examine you and together with you consider which measures may be relevant. PRT is one of several options for long-lasting pain conditions. You can read about physiotherapy at Dr.Dropin and psychomotor physiotherapy, or about low back pain.

What is nociplastic pain?

Nociplastic pain is caused by altered pain perception, without a specific injury in tissue or nerves explaining it. The pain can be amplified and widespread [1].

How long does PRT treatment take?

In the study the treatment consisted of a conversation with a doctor and eight sessions with a therapist over four weeks [2]. How a programme is arranged at Dr.Dropin is agreed with the practitioner.

Is PRT documented as effective?

A randomised trial with five-year follow-up has shown lower pain intensity in the PRT group for long-lasting back pain, but the study has limitations, and the knowledge does not apply to other pain conditions without further evidence [2][3].

Does PRT mean that the pain is not real?

No. The pain is real to the person who feels it. NHI describes that pain linked to psychological strain is experienced just as strongly and affects quality of life just as much as other types of pain [1].

Do I need a referral to see a physiotherapist?

No, you can book directly without a referral from a doctor.

You can read more about female athletes, common injuries and prevention. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Smerte (Pain). NHI.no. Last updated 21 February 2023. Link

2. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial. JAMA Psychiatry. 2022;79(1):13-23. doi:10.1001/jamapsychiatry.2021.2669. Link

3. Ashar YK, Low EL, Knight K, et al. 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. 2025;82(10):1049-1051. doi:10.1001/jamapsychiatry.2025.1844. Link

4. Physiotherapist Peder Solberg Aakvåg. Dr.Dropin Fysikalske. Link