favourite new physical pain resource
Kia ora friends,
This month my migraine prevention plan got an update. Now I spend many nights swaddled in blankets on the couch, watching 'Slow Horses', and chanting to myself you are safe, this feels good, there's no danger here, you are with your husband, this is nice, you are having fun right now!
[It sounds weirdly sarcastic and potentially toxically positive when I describe it here but imagine I'm explaining it with warmth and humour, it's actually good!]
This practice all started with Dr Jill Stoddard's recent post titled, "I Haven't Been This Excited About a Therapy in Years." She goes on to describe a new treatment for nociplastic or neuroplastic pain or chronic pain that is theorised to persist because of heightened pain signal processing of the central nervous system (CNS).
The treatment is called Pain Reprocessing Therapy (PRT) and has one successful randomised control trial with clinically and statistically meaningful patient benefits maintained at one-year and five-year follow up (citations at bottom). There's also a book and podcast interview you can listen to:
Pain Reprocessing Therapy (PRT), developed by Alan Gordon. By the end of that day, I had ordered Alan’s book, The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain. ... I also reached out to Alan to interview him on Psychologists Off the Clock (and he was awesome!)
Summary of PRT patient outcomes:
"PRT participants attended 1 telehealth physician session and 8 face-to-face therapist sessions aiming to help participants reframe their CBP as due to nociplastic processes,3 reduce fear and avoidance of pain, and regulate nonpain threats (eg, anxiety, difficult emotions).4"*citation below
For people who want more info on the practical details of the intervention, see pages 39-44 of this Journal of the American Medical Association supplement.
Changes I Personally Made Based On This New Pain Therapy
Here are a few ways my own pain evaluations and behaviour changed when applying the key ingredients of the intervention:
- I realised that my neck and head pain wasn't constant, that it ebbed and flowed based on the level of stress I was experiencing; as described in the research methods, this change was my own version of "promoting insight into links between emotional or psychological states and pain"
- I started tracking my fear of my pain and the ways I was overlimiting my behaviour. I realised I stopped doing things I enjoyed like watching movies with my family and I was avoiding stretching my neck because I was scared of hurting myself more.
- Via somatic tracking each day, I was able to investigate the pain (and my physical sensations more broadly) with warmth and curiosity, then focus on lowering my general threat level and promoting my own experience of safety.
Openings! & Podcast
- I will have openings in the next month for clinical care and supervision for medical professionals.
- "Start Here For Helpers" podcast coming soon - sign up at the link if you're keen.
Books I'm Loved This Month
- Hamnet by Maggie O'Farrell
- Sorrow and Bliss by Meg Mason
- Unmasking Autism by Devon Price
- The Wedding People by Alison Espach
- The Valley of Unlikely Acquaintances by Terri Te Tau (book launch happening 15 Sept at Unity Books Wellington)
Wishing you the sense of being awash in safety,
wishing you nights where you drift off as the ruru calls,
wishing you love that shines from you and on you as generous as the sun.
With all my heart - Kerry
*Ashar YK, Low EL, Knight K, Schubiner H, Gordon A, LeRoux A, Lumley MA, Wager TD. 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 Oct 1;82(10):1049-1051. doi: 10.1001/jamapsychiatry.2025.1844. PMID: 40736996; PMCID: PMC12311821.
Ashar YK, Lumley MA, Perlis RH, Liston C, Gunning FM, Wager TD. Reattribution to Mind-Brain Processes and Recovery From Chronic Back Pain: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2023 Sep 5;6(9):e2333846. doi: 10.1001/jamanetworkopen.2023.33846. PMID: 37768666; PMCID: PMC10539987.