Pain Reprocessing Therapy (PRT) in Seattle and Online in Washington

How the therapy works

The therapy combines education about what the method calls neuroplastic pain with practice in meeting pain sensations with less fear. One of its practices is somatic tracking, and in my sessions that means learning to approach physical sensations with safety and curiosity. In the method's model, as the brain learns that those sensations are safe, the pain can ease, and that is the change the therapy works toward.

My own writing approaches persistent pain in a related way. In a 2026 article in Psychotherapy Bulletin, I describe it as the nervous system signaling danger rather than as proof of tissue damage, with avoided feelings tied to conflict, loss or anger sometimes surfacing in the body.

What the research shows

In its landmark randomized trial, the therapy reduced chronic back pain far more than placebo or usual care did. The trial, published in JAMA Psychiatry in 2022 by Ashar and colleagues, enrolled 151 adults aged 21 to 70 in Boulder, Colorado, who had lived with back pain for an average of 10 years. Each was assigned at random to the therapy, an open-label placebo injection or usual care. The therapy began with one evaluation and education session with a physician, held by telehealth, followed by eight one-hour individual sessions, twice a week for four weeks. After treatment, 66% of the therapy group (33 of 50) were pain-free or nearly pain-free, meaning a rating of 0 or 1 out of 10, compared with 20% with placebo and 10% with usual care. A year later, the therapy group still had less pain than either comparison group.

The benefit was still there five years on. A 2025 follow-up by the same team heard from 113 of the 151 participants. Of the therapy group who took part, 55% (21 of 38) were pain-free or nearly pain-free, compared with 26% (10 of 39) with placebo and 36% (13 of 36) with usual care.

The trial also offers clues to how the therapy works. In a 2023 analysis by Ashar and colleagues, 51% of the causes that people in the therapy group gave for their pain after treatment were mind or brain processes, such as stress, compared with 8% in the comparison groups. People whose explanations shifted more tended to have less pain afterward. Brain scans also showed changes after the therapy in how regions involved in pain, such as the anterior insula and anterior midcingulate cortex, responded to back pain.

Working alongside your medical care

The therapy works alongside your medical care. In the main trial, the therapy itself began with an evaluation by a physician, and the Center's guidance for patients also advises checking with a medical provider first. Pain can have more than one source at once, and when it does, the Center notes that the therapy may still ease the added suffering while medical care continues. Physicians who want to refer a patient can start with information for referring clinicians.

How it fits with EAET and my other methods

This therapy is one of three methods I combine. Emotional Awareness and Expression Therapy (EAET) leads my work, and it helps you notice, feel and express emotions you may have learned to hold back, such as anger, grief and the longing for closeness. In its developers' model, those avoided emotions can keep the nervous system in a state of threat (Maroti and colleagues, 2025). PRT's tools address fear of the pain itself, and attachment-oriented psychodynamic therapy informed by ISTDP (intensive short-term dynamic psychotherapy) attends to longer-standing patterns in how you relate to yourself and to others. My approach explains how I balance the three for each person.

Emotion is part of how I work with pain, and my own research looks at it. In a 2024 study I led in The Journal of Pain, a survey of 673 Black, Latine and Asian American adults who reported chronic pain, more stressful life events went with more symptoms of centralized pain. Anger and perceived injustice (a sense of having been wronged) each carried part of that link.

Who the therapy may help

The therapy may suit you if you want to understand how your brain and nervous system shape the pain you feel and to practice meeting it with less fear, alongside the care of your physician. Its landmark trial was in chronic back pain, and it is now being studied in other conditions, including fibromyalgia. I work especially with high-achieving professionals who are used to solving hard problems, until their bodies stop cooperating.

Sessions and fees

I see each person individually, by secure video anywhere in Washington or in person on Fridays at my office at 5108 196th St SW, Suite 103, Lynnwood, WA 98036. We begin with a 60-minute initial consultation, in which we go over your symptoms, the medical care you have had and what you want from treatment, and then plan the work together. Ongoing sessions are 60 minutes. The practice is private pay and does not bill insurance; the initial consultation is $325 and ongoing sessions are $265, and services and fees lists every option.

Frequently asked questions

Is pain reprocessing therapy legitimate?

Yes. It is a structured psychological treatment that has been tested in randomized trials. In its landmark trial, published in JAMA Psychiatry in 2022, two thirds of the adults with chronic back pain in the therapy group were pain-free or nearly pain-free after four weeks of treatment.

What is neuroplastic pain?

Neuroplastic pain is the term this therapy uses in its education about pain. The closest research term is nociplastic pain, which the International Association for the Study of Pain describes as pain arising from altered processing of pain signals without clear evidence of tissue damage or nerve disease. It is real pain, and a person can have it alongside pain from an injury or disease.

How long does it take?

In its main trial, treatment took four weeks: one evaluation and education session with a physician, then eight one-hour therapy sessions, twice a week. We decide the pace and length of your treatment together after the initial consultation and review it as we go.

Does it work for fibromyalgia?

Early results are encouraging. In a 2025 pilot study by Sturgeon and colleagues, 35 adults with fibromyalgia began a three-session version of the therapy, one-on-one by video. Thirty-three completed it, and their pain fell over the following three months. EAET, the method I lead with, has also been tested in fibromyalgia, where it improved overall symptoms more than CBT.

Does it work for migraines?

Research in migraine is just beginning. In a 2025 case series in Headache by Fishbein and colleagues, headache days fell substantially in all three adults with chronic migraine who received the therapy. For migraine and chronic headache, my work centers on EAET and attachment-oriented psychodynamic therapy, and my page on migraine and chronic headache describes how I work with headache alongside your physician or neurologist.

Book a free discovery call

A free discovery call is the simplest place to start: we talk about your pain, the care you have had so far and how I work, and then decide together whether to book an initial consultation.

Book a free discovery call

References

Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: A randomized clinical trial. JAMA Psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669

Ashar, Y. K., Low, E. L., Knight, K., Schubiner, H., Gordon, A., LeRoux, A., Lumley, M. A., & Wager, T. D. (2025). 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, 82(10), 1049–1051. https://doi.org/10.1001/jamapsychiatry.2025.1844

Ashar, Y. K., Lumley, M. A., Perlis, R. H., Liston, C., Gunning, F. M., & Wager, T. D. (2023). Reattribution to mind-brain processes and recovery from chronic back pain: A secondary analysis of a randomized clinical trial. JAMA Network Open, 6(9), Article e2333846. https://doi.org/10.1001/jamanetworkopen.2023.33846

Fishbein, J. N., Schuster, N. M., Anders, A., Portera, A. M., & Herbert, M. S. (2025). Pain reprocessing therapy for migraine: A case series. Headache, 65(9), 1660–1665. https://doi.org/10.1111/head.15043

International Association for the Study of Pain. (n.d.). Terminology. Retrieved October 31, 2026, from https://www.iasp-pain.org/resources/terminology/

Jin, J. (2026, July). Danger, not damage: Attachment, emotion, and the somatic language of relational threat. Psychotherapy Bulletin, 61(4). https://societyforpsychotherapy.org/danger-not-damage-attachment-emotion-and-the-somatic-language-of-relational-threat/

Jin, J., & Yarns, B. C. (2024). The impact of stressful life events on centralized pain and pain intensity: A combined model examining the mediating roles of anger and perceived injustice among racially minoritized adults with chronic pain. The Journal of Pain, 25(11), Article 104642. https://doi.org/10.1016/j.jpain.2024.104642

Maroti, D., Frisch, S., & Lumley, M. A. (2025). To feel is to heal: Introduction to Emotional Awareness and Expression Therapy. Der Schmerz, 39(4), 256–262. https://doi.org/10.1007/s00482-025-00878-6

Sturgeon, J. A., Trost, Z., Ashar, Y. K., Lumley, M. A., Schubiner, H., Clauw, D., & Hassett, A. L. (2025). Brief pain reprocessing therapy for fibromyalgia: A feasibility, acceptability, and preliminary efficacy pilot. Regional Anesthesia & Pain Medicine. Advance online publication. https://doi.org/10.1136/rapm-2025-107076