The Science Behind The Chronic Pain Reset Method

A Primer On the Science of Chronic Pain

The MRI Myth: Why “Abnormalities” Don’t Explain Chronic Pain

For decades, advances in imaging—especially MRI—led clinicians to assume that anything visible on a scan must be the source of a patient’s pain. But over the past ten years, researchers began scanning asymptomatic people: individuals with no pain at all.

The results were groundbreaking.

They found that the same “abnormalities” seen in people with chronic pain—disc bulges, degeneration, tears, narrowing—were also present in the vast majority of pain-free adults. These findings are now known as “normal abnormalities.” They appear just as commonly in healthy, active adults as in people seeking care.

What we once believed were structural causes of pain are now understood to be normal signs of aging, much like having grey hair on the inside.

This shift in understanding explains:

• why back surgeries have extremely low long-term success rates
• why sham knee-surgery trials show similar outcomes to real surgeries
• why corticosteroid injections frequently perform no better than saline

In short:
Healthcare providers spent years trying to “fix” structural findings that science now shows are not the drivers of chronic, ongoing pain. If nearly everyone has the same findings on MRI—whether they hurt or not—those findings cannot explain persistent symptoms. Something else must be happening. This is where approaches like Pain Reprocessing Therapy come in.

According to the National Institutes of Health (NIH), chronic pain can continue even after the body has healed because the brain keeps interpreting signals as threats.

The Breakthrough: Watching the Brain Learn Pain—the Science of Chronic Pain Comes Into Focus

As these studies emerged, imaging technology took another leap forward with functional MRI (fMRI). Unlike traditional MRI, which takes a still picture, fMRI shows the brain in action—what’s active, what’s firing, and how different networks communicate.

This opened an entirely new world of discovery i the science of chronic pain.

Researchers observed:

• Pain moving over time from physical-sensation regions of the brain to areas involved in learning, habit formation, and emotion
• Distinct differences between the brains of people whose acute pain faded naturally and those whose pain persisted
• Predictable activity patterns that could forecast whether someone was likely to develop chronic pain

These findings are now supported by hundreds of studies, all demonstrating that chronic pain is maintained by neural circuits and central nervous system patterns—not by ongoing physical damage. These discoveries also inform the work we do in the small-group pain recovery program, where people learn practical ways to retrain overactive pain circuits.

Findings from CANlab at Dartmouth demonstrate how the brain’s threat-detection systems can generate real pain even when tissues are structurally healthy.

The Early Pioneers Who Saw the Chronic Pain Pattern First

Long before brain imaging could confirm it, a handful of clinicians noticed that stress, trauma, emotional suppression, and prolonged life pressures played an enormous role in persistent pain syndromes.

One of the most well-known was Dr. John Sarno, a rehabilitation physician at NYU. He coined the term Tension Myositis Syndrome (TMS) and helped tens of thousands of people through education, emotional awareness, and mind–body reconnection. He wrote several bestselling books and trained many practitioners who continued his work. Learn about my individual and group programs that are an evolution of Dr Sarno’s work.

But because imaging tools capable of validating his theories did not exist in his lifetime—and because mind–body discussions were not widely embraced at the time—his ideas remained outside mainstream medicine for many years.

Research from the Stanford Pain Lab shows that the brain plays a central role in how pain is created, interpreted, and sustained.

The Modern Convergence: Neuroscience Validates What Clinicians Observed

About a decade ago, a group of physicians from multiple specialties—many of whom were familiar with Sarno’s early work—began comparing notes. Across orthopedics, neurology, family medicine, physiatry, psychiatry, and pain psychology, they all reported remarkably similar patterns:

Patients with chronic pain often had:

• A history of prolonged stress, trauma, or emotional overload
• Nervous systems stuck in a heightened protective state
• Pain appearing in different body locations over time
• Imaging findings that did not correlate with the severity of symptoms

Their collective clinical experience aligned with modern research in the science of chronic pain: ongoing pain often stems from central sensitization—a brain and nervous system stuck on high alert—not from continuing structural injury.

This pattern of pain amplification is consistent with what the Cleveland Clinic describes as central sensitization, where the nervous system becomes more reactive over time.

This interdisciplinary conversation sparked a formal collaboration.

The Association for the Treatment of Neuroplastic Symptoms

These clinicians founded the Association for the Treatment of Neuroplastic Symptoms to bring together scientific evidence, clinical expertise, and patient education in one unified organization.

Over the last decade, the ATNS has:

• Published books and peer-reviewed papers
• Created training programs for medical providers
• Supported research advancing our understanding of chronic pain
• Provided education to help patients shift out of chronic pain patterns

Their work helped establish the scientific foundation that methods like the Chronic Pain Reset Method now build upon—empowering people to retrain overactive pain circuits, calm an overprotective nervous system, and return to comfortable, confident movement. If you’d like to explore how this applies to your own pain pattern, you can schedule a consultation.

Pain Reprocessing Therapy: A New Approach to Chronic Pain Recovery

The Research Breakthrough

In 2021, a landmark randomized clinical trial—the Boulder Back Pain Study, conducted at the University of Colorado Boulder—was published in JAMA Psychiatry, one of the most respected peer-reviewed medical journals. This study showed that a non-invasive, neuroscience-based approach called Pain Reprocessing Therapy (PRT) led to significant and lasting improvement in chronic back pain for many participants, even among those who had experienced symptoms for years.

Importantly, the study was carried out by an interdisciplinary team including neuroscientists, physicians, and psychiatrists. The only intervention used with participants in the treatment group was Pain Reprocessing Therapy.

Researcher Yoni Ashar, PhD, has contributed extensively to the study of brain-based chronic pain and the development of Pain Reprocessing Therapy.

You can find this study—and many other related publications—further down the page, under “My Favorite Research To Share”.

How the Science of Chronic Pain Fits Into the Chronic Pain Reset Method

My Mind-Body Program is based on the same principles as Pain Reprocessing Therapy. PRT is a non-invasive, neuroscience-informed, educational and experiential approach designed to help the brain reinterpret pain signals and shift out of learned pain patterns.

A Dartmouth summary of the Pain Reprocessing Therapy trial explains how shifting the brain’s interpretation of danger can lead to measurable reductions in chronic pain.

Decades of research show that the brain and central nervous system play a central role in the creation and maintenance of chronic pain. PRT directly addresses these neural processes through:

• evidence-based pain education
• somatic awareness
• emotional processing
• nervous system regulation
• cognitive and perceptual retraining

This is the same scientific foundation that the Chronic Pain Reset Method is built upon.

A Growing Body of Evidence In the Science of Chronic Pain

Over the last twenty years, research on the brain’s role in persistent pain has expanded dramatically. Functional imaging, longitudinal studies, and neuroscience frameworks have converged to reshape how chronic pain is understood—and how it can improve.

If I could highlight one study for anyone exploring this field, it would be:

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain
(JAMA Psychiatry, 2021)

This randomized clinical trial—funded and supported by the Psychophysiologic Disorders Association (PPDA)—was the first to demonstrate such substantial and lasting improvement in chronic back pain using a single structured intervention: Pain Reprocessing Therapy.

Key findings:

• Functional MRI scans showed observable changes in pain-related neural pathways before and after PRT, indicating that the brain itself was reorganizing in response to the intervention.
• More than half of participants receiving PRT experienced major, meaningful improvement in their back pain at the one-year follow-up.
• The PRT group showed significantly better outcomes than both the placebo and usual care groups.
• Even participants who did not reach full symptom resolution experienced meaningful improvement.

These principles also guide the way I work with clients in my small-group pain recovery program.

• Washington Post article discussing the research: Chronic pain is surprisingly treatable – when patients focus on the brain. An unexpected therapy shows results.
• Times of London article reporting on the same study: Is this a cure for chronic back pain? A new study has reported a remarkable success rate using only psychological methods.
• additional Times of London coverage: Retrain your brain: is it the cure for back pain? Recent research suggests the key to chronic back pain is not drugs.

What This Means For You

Decades of research point to one clear conclusion: chronic pain is often maintained by the brain and nervous system—not by ongoing damage in the body. When the nervous system learns a pain pattern, it can continue to send danger signals long after tissues have healed.

The hopeful part is this:
What the brain learns, it can also unlearn.

This doesn’t mean the pain is “in your head.” It means the system that generates pain has become overprotective—and with the right education, awareness, and tools, it can be guided back toward a calmer, safer baseline.

An NIH overview of brain-based pain retraining highlights how changing the brain’s threat response can reduce persistent pain.

In practice, this looks like:

• understanding how pain circuits are formed
• reducing fear around pain sensations
• learning to interpret signals through a new lens
• practicing techniques that calm an overactive nervous system
• gradually restoring a sense of safety and ease in movement

This is the scientific foundation behind the Chronic Pain Reset Method, and it’s why so many people feel more hopeful once they understand how chronic pain actually works.

Ready to Explore This Work Yourself?

If you’re curious how this science applies to your own symptoms, there are a few ways to explore this work more deeply:

• Learn more about the Chronic Pain Reset Method
• Join the small-group pain recovery program to practice these tools in a supportive setting
• Schedule a consultation to talk through your pain pattern and see whether this approach is a good fit

You don’t have to make sense of chronic pain alone.
When you understand what your brain and nervous system are doing—and why—you can begin to shift long-standing patterns and move toward more comfort, confidence, and ease.

My Favorite Research To Share:

Below is a selection of research I often share with clients and friends who want to understand more about the neuroscience of chronic pain. For a comprehensive, annotated list of major studies, I recommend visiting the Psychophysiologic Disorders Association Bibliography.

• Predicting transition to chronic pain. Properties of the brain’s emotional learning circuitry predict the transition to chronic pain.: Researchers tracked patients for one year following an initial episode of back pain, including taking brain scans of emotion-related circuitry to assess emotional activity at the outset of their acute pain. Researchers reported in this study that they were able to predict with 85% accuracy who would develop chronic pain based on the early brain scans, representing the patients’ emotional mindset, alone.
• Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Back Pain: Researchers scanned the brains of patients experiencing chronic back pain in different environments in the lab and found that spontaneous chronic back pain is observed in brain regions known to be involved in negative emotions, response conflict, and detection of unfavorable outcomes, especially in relation to the self. These findings led the authors to suggest the emotional brain, especially regions pertaining to ideas of the self, is a key player in chronic low back pain.
  • From the conclusion of the study: “The current study is the latest of a series we have been conducting to examine the brain in CBP. Together, how do these studies impact the current viewpoint regarding CBP? The common clinical approach to CBP is to relate its behavioral manifestations to the site of injury. Although some CBP patients have identifiable structural or mechanical cause for their pain, most do not (Cavanaugh and Weinstein, 1994; Boos et al., 1995; Deyo, 1998). Given the poor association between structural abnormalities to pain, other nonspecific variables have been proposed as predictors of clinical outcome, like demographics including age, gender, and education (Boos et al., 1995), psychosocial factors such as level of depression, anxiety, pain catastrophizing, fear and/or helplessness, job satisfaction, and environmental reinforcers such as compensation and litigation (Greenough, 1993; Keefe et al., 2004).

• Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits: Researchers compared the brains of back pain patients who had symptoms for two months (with no history of pain) and patients who had suffered back pain for at least 10 years. They also tracked and scanned the acute back pain patients for one year, and continued to examine the brains of patients whose pain went on to become chronic. The researchers reported that acute pain was seen on scans in areas of the brain limited to physical pain sensation, while chronic pain was seen in regions limited to emotion-related circuitry.
  • Science Magazine article about these findings: Blaming the Brain for Chronic Back Pain. A brain scan may be able to predict whether a patient with back pain will recover or develop persistent pain.
• A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee: Double Blinded study on 180 patients randomly assigned to undergo arthroscopic debridement, arthroscopic lavage, or placebo surgery. In this trial, the authors found that neither intervention group reported less pain or better function than the placebo groups.
  • Scientific American article about these findings: Study Suggests Common Knee Surgery’s Effect Is Purely Placebo

• Failed Back Surgery Syndrome: Pain Medicine Journal Article; According to this Pain Medicine article, research cited by the authors indicates that many commonly performed back surgeries may be no more effective than “sham” surgeries.
• Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations: Radiological findings in people with no back pain indicate, according to the authors, that spinal degeneration is common and often seen on MRI in the absence of any pain. 
  • From the conclusion of the study: “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”

• No stress–no whiplash? Prevalence of “whiplash” symptoms following exposure to a placebo rear-end collision: 51 participants experienced a simulated crash. Three days later, 20% of them had neck pain that they attributed to the crash, and one month later 10% of them still suffered from symptom, even though there was no way they suffered an actual injury from the “crash.”

• Situational and psychophysiological factors in psychologically induced pain: “To investigate pain that occurs in the absence of painful stimulation, normal subjects were connected to a sham stimulator and were told that a headache could occur as a result of the electrical current they would receive. Half of the subjects who received this suggestion reported pain. Pain ratings increased as the settings of the sham stimulator were increased.” The authors reported that, in this experimental setting, pain responses could be induced by psychological suggestion, even without tissue damage. They suggested that belief and expectation can influence the experience of pain.
• Cerebral activation during hypnotically induced and imagined pain: Subjects were placed in an fMRI machine as pain was administered with a hot probe, and watched the pain regions of their brain light up. The same subjects were again monitored via fMRI as they were hypnotized and pain was induced via suggestion – in the absence of any physical stimulation. When subjects were hypnotized the suggested pain lit up the same brain regions as the pain from the hot probe did. The subjects’ brains reacted the same to physically and hypnotically induced pain. The authors described this study as providing “the first direct experimental evidence in humans linking specific neural activity with the immediate generation of a pain experience.”
• Increased bias to report fear or pain following emotional priming of pain-related fear: Participants received random but equally hot pulses on their skin while looking at images that were either scary or neutral. Subjects reported much more pain while looking at the scary photos; sometimes the subjects reported pain while looking at the scary photos, even when the hot pulses were off. The authors observed that fear increased sensitivity to pain in this study, potentially turning a neutral sensation into a painful one.

• Human brain mechanisms of pain perception and regulation in health and disease: Review of Research, “The nociceptive system (pain sensing system) is now recognized as a sensory system in its own right.” Reviewers found that the brains of people experiencing acute pain were fundamentally different from those experiencing acute pain, in that chronic pain activates regions associated with emotions and cognitive function. Thus this component of pain might be a specifically distinctive attribute of chronic pain. They also conclude that an understanding of how the pain sensing system in the brain transmits information to the body – instead of a focus on information traveling the other way around – is crucial to understanding human perception of pain and suffering.