Pain Reprocessing Therapy (PRT) in Ontario: A Different Path Forward

PRT is evidence-based and grounded in peer-reviewed research, most notably a 2022 randomized controlled trial published in JAMA Psychiatry, one of the most rigorous psychiatric journals. The concern you may have heard, that PRT dismisses pain as imaginary or “all in your head,” is a mischaracterization of how the therapy works. Neuroplastic pain, which PRT targets, is real pain with a neurological mechanism: the brain’s threat-detection system has become sensitized and generates genuine pain signals in the absence of ongoing tissue damage. PRT does not tell people their pain isn’t real. It explains why the pain is real and provides structured techniques to change the brain patterns that sustain it.

Pain Reprocessing Therapy is a structured psychological treatment designed to address neuroplastic pain, chronic pain that persists not because of ongoing tissue damage, but because of how the brain has learned to generate and interpret pain signals. PRT works with the brain’s capacity for change, known as neuroplasticity, to reduce or eliminate pain at its source. It was developed by psychologist Alan Gordon, LCSW, and validated in a 2022 JAMA Psychiatry clinical trial.

PRT gained significant scientific credibility through a landmark 2022 randomized controlled trial published in JAMA Psychiatry, which found that 66% of PRT participants were pain-free or nearly pain-free after treatment, compared to 20% in a placebo group and 10% in a usual care group. The study was conducted by Dr. Yoni Ashar and colleagues at the University of Colorado.

Somatic tracking is one of PRT’s most distinctive techniques. It involves attending to pain sensations with curiosity and safety rather than fear. Rather than bracing against pain, you learn to observe it as a sensation, noticing its qualities without catastrophizing. This approach directly interrupts the fear-pain cycle that maintains neuroplastic pain.

PRT is designed for neuroplastic pain, pain that has persisted beyond the normal healing timeline or that fluctuates based on emotional or psychological states rather than physical activity. This includes chronic back pain and neck pain without structural cause, fibromyalgia, migraines and tension headaches, irritable bowel syndrome (IBS), chronic fatigue and widespread pain conditions, repetitive stress injuries that persist despite physical treatment, and pain that worsens with stress, improves on vacation, or varies with mood. PRT also addresses neuroplastic symptoms such as dizziness, tinnitus, IBS and gut symptoms, Functional Neurological Disorder (FND), POTS, and Long Covid where neuroplastic sensitization is a contributing factor.

Pain Reprocessing Therapy (PRT) differs from CBT and mindfulness in one key way: its goal is to eliminate neuroplastic pain at its source, not improve how you cope with it. PRT targets the brain’s learned pain response directly, using somatic tracking with safety and curiosity, not thought restructuring or neutral detachment.

CBT for pain focuses on changing the thoughts and behaviours that worsen symptoms; it helps you function better despite pain. PRT’s aim is more specific: to teach the brain that the pain signal itself is not a threat, interrupting the neuroplastic cycle rather than managing around it.

Mindfulness supports PRT by developing present-moment body awareness, but the two techniques use a different emotional stance. Where mindfulness cultivates neutral observation, PRT’s somatic tracking uses active feelings of safety and curiosity, a distinction that matters clinically for pain reprocessing.

CBT and PRT are complementary, and many clients benefit from elements of both. However, if the root driver of your chronic pain is neuroplastic sensitization, PRT addresses that mechanism in a way that CBT and mindfulness alone do not.

A standard course of PRT involves approximately 8 to 12 sessions, though this varies depending on pain duration, severity, and individual response. Research suggests that meaningful improvements often appear within the first few sessions, with the most significant gains occurring across the full treatment arc. Sessions are typically 50 minutes in length.

PRT sessions at Sky Therapies are conducted online via secure video, available to anyone located in Ontario. In early sessions, your therapist focuses on pain education and assessment, mapping your specific pain history, identifying potential neuroplastic indicators, and establishing the foundation of safety that PRT requires. As sessions progress, somatic tracking and emotional processing work become central.

Yes. All PRT services at Sky Therapies are delivered online via secure video to anyone located in Ontario. Pain Reprocessing Therapy does not require in-person physical assessment. It is a conversational and psychological intervention that translates fully to video. Online delivery means you can access evidence-based PRT from any location in Ontario, without travel, without waiting rooms, and on a schedule that works with your life.

No. You do not need a medical referral to begin PRT at Sky Therapies. However, our clinical team always recommends coordinating with your physician to rule out structural causes before beginning psychological pain treatment.

Neuroplastic pain is chronic pain that persists not because of ongoing tissue damage, but because the nervous system has become sensitized over time. It generates real, intense pain signals even after physical injury has healed or in the absence of structural damage. Common indicators include pain that moves locations, pain that worsens with stress but not activity, normal medical imaging despite ongoing pain, and pain that began during a stressful life period.

Sessions with a Registered Social Worker or Registered Psychotherapist may be partially covered by extended health benefits that include psychotherapy or social work services. Coverage varies by plan. Sky Therapies can bill select insurance providers directly. Contact us for current session rates and to verify your coverage.

PRT is most effective for people whose chronic pain has persisted for three months or longer despite treatment, fluctuates significantly based on emotional state, stress, or context, spreads or moves across the body over time, was triggered by a stressful life event not just physical injury, has not responded to structural interventions like surgery, physiotherapy, or injections, and improves in situations of safety, relaxation, or distraction. PRT is not appropriate as a replacement for medical assessment.

The first step is a free consultation. Your therapist will discuss your pain history, the characteristics of your symptoms, and what a course of PRT at Sky Therapies might look like for you. You can schedule your consultation directly through our website or call us at 437-889-8427.