You have been living with pain for a long time. Maybe years. Maybe decades. You have seen doctors. You have had the MRIs and the X-rays. Depending on the kind of pain, you have been told different things: there is some degeneration but nothing that explains your level of pain, or the imaging is clear and no one is sure why you are still hurting, or yes there was an injury but it should have healed by now. You have tried physiotherapy, medication, rest, exercise, massage, chiropractic, cortisone. Some of it has helped a little. None of it has made the pain go away.
This post is for you. It is about a specific kind of chronic pain that most medical care is not set up to treat: pain that has become a learned pattern in the nervous system, rather than a signal that something is currently damaged in the body. The research on this kind of pain has shifted substantially in the last several years, and the therapeutic approaches now available are meaningfully different from what was possible even a decade ago.
I am a Vancouver-based psychotherapist working online across Canada. My clinical training includes Sensorimotor Psychotherapy certification, Senior Facilitator status in Trauma-Informed Stabilization Treatment, and board-certified art therapy. All of these approaches meet chronic pain where it actually lives, which is in the nervous system.
When pain stops being a messenger
Pain is, in most cases, a useful signal. You touch a hot stove, your nerves send a pain signal to your brain, you pull your hand back. The system is doing exactly what it should.
Chronic pain is different. When pain persists for months or years past the point when any initial injury has healed, or when no clear injury is ever identified, something else is happening. The pain system itself has changed. Your nervous system has learned to generate pain even when the body is no longer under threat. This is not a character flaw, a weakness, or an imagined symptom. It is a specific neurological phenomenon that researchers now have good tools to describe.
Alan Gordon, the founder of the Pain Psychology Center in Los Angeles, developed an approach called Pain Reprocessing Therapy specifically for this kind of pain. In his book The Way Out, he describes it this way: neuroplastic pain is pain that has gotten stuck because the brain has learned it too well. The nervous system gets better and better at firing the pain pathway, and eventually the pain no longer requires any physical trigger to activate.
The research changing how chronic pain is understood
In 2021, researchers at the University of Colorado Boulder published a randomized clinical trial in JAMA Psychiatry that tested Pain Reprocessing Therapy against placebo and usual care for people living with chronic back pain. At the end of the four-week protocol, 66 per cent of patients who completed the PRT treatment were pain-free or nearly pain-free. Most maintained their relief at one-year follow-up. A five-year follow-up published in 2025 showed the gains largely held.
These are remarkable numbers for a field where most chronic pain treatments offer modest, temporary relief. And the study included people whose imaging showed significant findings. One participant had scoliosis at a seventy-three-degree angle. Another was a former college football player with two large disc herniations and partial nerve-root compression who had been in pain for thirty years. Both ended the study without pain.
This does not mean all chronic pain is neuroplastic. Some pain is structural and requires medical treatment. What the research does mean is that for a significant portion of people living with persistent pain, the mechanism maintaining the pain is not in the tissue but in the nervous system's learned interpretation of signals from that tissue. And that is treatable.
What's happening in the nervous system
To explain why this works, it helps to understand what chronic pain is doing inside you. Your nervous system has two basic modes relevant to pain. The first is a state of calm, sometimes called ventral vagal activation, where the body reads its environment as generally safe. In this state, the pain threshold is relatively high, and mild sensations feel mild.
The second is a state of high alert, where the body reads its environment as potentially threatening. In this state, the pain system becomes sensitised. Sensations that would feel neutral in a calm state get amplified. The nervous system is doing its job: turning up the volume on anything that might signal danger, so you respond quickly.
For someone living with chronic pain, especially chronic pain with a history of trauma or prolonged stress, the nervous system often gets stuck in the high-alert state. The pain keeps firing because the body keeps reading the sensations as threatening. And because the pain keeps firing, the body keeps staying on high alert. It becomes a loop.
Some of what keeps this loop going is psychological: fear of the pain, avoidance of movement, the meaning we make of the pain ("I'm broken," "this will never end"). Some of it is somatic: chronic muscle bracing, shallow breathing, a body that has forgotten what neutral feels like. Some of it is trauma-related: a nervous system that learned early to stay vigilant and has not yet been given reason to stand down.
The good news is that loops can be interrupted. That is what this work is about.
What nervous-system-based chronic pain therapy actually involves
Several therapeutic approaches address chronic pain through the nervous system. They share a common foundation: the goal is to help the brain reinterpret sensations as safe rather than threatening, so the pain pathway can quiet down and eventually switch off.
In my practice, the relevant approaches include Sensorimotor Psychotherapy, which works directly with the body's sensations, postures, and movement patterns to help the nervous system settle; embodied parts work, which addresses the parts of the self that have been holding the fear or bracing around the pain; and TIST, for clients whose chronic pain is interwoven with complex trauma that needs its own careful attention.
Across these approaches, the work tends to involve a few common elements.
We pay attention to what your body is actually doing in the present, not what your body "should" be doing. This is different from most medical and physio approaches, which often ask you to push through sensation. In this work, we slow down enough to notice what is there.
We build what somatic clinicians call a "felt sense of safety." This is the nervous system experience of settling, of not being braced, of being in a body that is allowed to relax. Many chronic pain clients have not felt this in years. Building it back is slow, incremental, and worth the time.
We gently reduce the fear attached to specific sensations or movements. This is not exposure therapy in the traditional sense. It is more like a quiet conversation between you and your nervous system, where over time, movements and sensations that have been coded as dangerous can be recoded as safe.
We address what is underneath. Chronic pain rarely exists in isolation. It often sits alongside anxiety, depression, grief, unprocessed trauma, or long-standing patterns of over-functioning and never resting. The work meets these as part of the whole picture, not separately.
What changes, over time
Clients who do this work sometimes describe a gradual quieting of the pain rather than a dramatic disappearance. The pain lifts by degrees. The fear around the pain lifts sooner than the pain itself, and that alone changes the texture of daily life. Movement becomes possible again. Sleep improves. The catastrophic mental loop that often accompanies chronic pain (this is permanent, nothing will help, I'm damaged) starts to loosen.
For some clients, especially those following the Pain Reprocessing Therapy model closely, the pain can reduce substantially or resolve entirely. For others, the work brings a different kind of relief: the pain may still be there but it no longer runs your life. Both are meaningful outcomes.
This work is not a replacement for necessary medical care. If you have a condition that needs surgery, you still need surgery. If you have an infection, you need to speak with your doctor. What this work offers is a different path for the specific kind of pain that medical care cannot reach, because the mechanism is not in the tissue but in the nervous system's learned response.
If you are curious whether your chronic pain might respond to this approach, our trauma-informed parts therapy service page describes the related clinical work we offer. A self-assessment quiz and more information on neuroplastic pain is available at Pain Psychotherapy Canada, a Canadian practice specialising in this kind of work.
You have been in pain for a long time. You have not been failing to try. The approaches that have not worked were not designed to reach what is actually happening in you. There are approaches that might. You do not have to be certain before starting. A consult is a conversation, not a commitment.
Frequently Asked Questions
How do I know if my chronic pain is neuroplastic?
You do not have to know before we start. Some indicators that often point toward a neuroplastic component: pain that shifts location or intensity without clear physical reason, pain that worsens during stress and eases during vacation or engaging activity, pain that is out of proportion to what imaging shows, or pain that has persisted long past when any injury should have healed. A self-assessment quiz is available through Pain Psychotherapy Canada, and a consult with me is another way to think this through.
Is this work saying my pain is "all in my head"?
No. The pain is real. You are genuinely experiencing it. What the research shows is that in many cases, the pain is being generated and maintained by the brain and nervous system rather than by ongoing tissue damage. That distinction matters because it tells us where the work needs to happen. "All in your head" dismisses the experience. "In your nervous system" takes it seriously.
Do I need to stop my pain medication?
No. Decisions about medication belong to you and your prescribing clinician, not to me. Many clients stay on their medications throughout this work. Some find, over time, that they need less. That is a conversation with your doctor, not with your therapist.
How long does this work take?
Longer than a short-term protocol, though not as long as many chronic pain treatments. Alan Gordon's published research on Pain Reprocessing Therapy used a four-week protocol, but the somatic and parts-informed approach I use is generally paced over several months, with meaningful shifts often emerging in the first three months. The pace is set by your nervous system, not by a timeline.
What if I have both chronic pain and a trauma history?
This is common. Many clients with treatment-resistant chronic pain have a trauma history that has kept their nervous system on high alert for years. Working with both layers together, rather than separately, tends to be more effective than trying to address one while ignoring the other. TIST is particularly well-suited to this pairing.
