Chronic pain isn’t “just in your head”— but there’s a good chance that it’s neuroplastic pain caused by a nervous system stuck in a danger-pain cycle. In this post I’ll summarize the main points of Alan Gordon’s book, The Way Out, and introduce you to the principles of Pain Reprocessing Therapy (PRT). Alan has 7 techniques to retrain your brain and find relief from chronic back pain, neck pain, and headaches. Find out how somatic tracking and messages of safety can help you unlearn pain and heal your nervous system.
Alan Gordon’s Journey Healing Chronic Back Pain
In his mid-twenties, author and therapist Alan Gordon suffered from chronic pain. He developed debilitating low back pain and headaches. A slew of doctors gave him a slew of diagnoses, but his pain got worse and spread to other parts of his body. He stopped hanging out with friends, couldn’t hold a job, and moved back in with his parents.
When his mom gave him a book about the mind-body connection with chronic pain, Alan literally threw it across the room. His pain was real, and he didn’t need anyone telling him that it was “just in his head”.
And, decades later, after healing his chronic pain, and running research studies on chronic pain, he would tell you now that he was right—at least partially. Chronic pain isn’t just “in your head”. It’s not just “anxiety” and it can’t be magically cured by just meditating more. But what he did learn, the piece that massively decreased his back pain, was that pain can’t exist without the brain.
Understanding Chronic Pain: Acute vs. Neuroplastic Pain
When we hurt, we all feel pain in that part of our body–our back, our neck, our knees. But, the only reason we feel pain is because of the messages that get sent up to our brain, where our brain interprets them. (If you had a complete spinal cord injury, and you hurt your leg, you wouldn’t feel any pain, because that message couldn’t make it to the brain.)
Where am I going with this? There are two types of pain: Acute Pain, and Neuroplastic Pain. One of them is caused by an injury, the other is caused by a nervous system dysfunction, where pain signals and your brain’s interpretation of them become wired—through fear—to make your pain louder and louder.
So how do you know if your pain is real? Do you feel pain? Yes? Then it’s real.
Alan’s pain, like yours, was real. Chronic neuroplastic pain can literally be seen in the nervous system using fMRI scanners (1.“Cerebral activation during hypnotically induced and imagined pain.” Neuroimage 23, no. 1 (2004): 329-401).
It shows up in brain areas like the anterior cingulate cortex, which monitors for danger; the insula, which tracks internal body sensations and assigns meaning to them; and the amygdala, which fires off fear and anxiety emotions in response to threats.
What’s different about acute pain, vs. neuroplastic pain is that neuroplastic pain doesn’t respond well to medical interventions like surgeries and physical therapy. Hundreds of thousands of chronic pain patients know from experience that interventions just seem to make it worse.
Pain Reprocessing Therapy: A Science-Backed Approach to Pain Management
Now I’m not a doctor, but chronic pain specialists agree that chronic pain can be fueled by psychological processes, so I’m here to summarize that information from his book The Way Out to make it easier to access.
And here’s the good news, there are excellent treatments for neuroplastic pain. It’s what led Alan Gordon to develop a protocol called Pain Reprocessing Therapy. PRT is backed by high-quality scientific research. In one PRT study, 98% of participants saw some decrease in their pain levels over the course of the study, and 66% of participants ended the study either pain-free or nearly pain-free after the PRT treatment. Brain imaging also showed changes in brain networks tied to pain processing. And those amazing results were still there when researchers checked in a year later.
So, even if you have a diagnosis for the source of your chronic pain, will you at least consider for the next few minutes that your nervous system’s response to your physical pain might be aggravating it? I hope you’ll give this video and Alan Gordon’s book a chance to help you. Our bodies are resilient, and sometimes we need to change our relationship with pain in order to relieve or release it.
I’ll share with you some common signs that your pain might be fueled by a nervous system response, and 7 techniques that Alan recommends for turning off neuroplastic pain. I’ll also tell you about my editor who pointed me to this book. She had chronic pain in her shoulder and lower back for nearly 3 years and spent a ton of money trying to fix it. Within a few weeks of reading the book and doing the techniques, her pain is practically gone.
Pain Management: How the Brain Creates Chronic Pain
OK, so pain happens in the body and the brain.
If I burn my hand while cooking, I feel pain. My brain interprets that signal as dangerous—my hand could get damaged!—and it quickly reacts by pulling my hand back.
When we sprain an ankle the injured body part sends a message of pain to the brain so we’ll be gentle and let the part heal. Pain messaging is an important part of protecting our body from further injury. And it’s closely connected to an interpretation: danger!
But what if that pain signal switch gets stuck in the “on” position? That’s what we call neuroplastic pain. The messaging from the body, and the danger signals in the brain can get confused.
Pain isn’t always tied to actual bodily injury—it can be triggered by the brain’s perception of danger. The nervous system pathways that interpret danger and those that interpret pain are highly overlapping. So pain can feel like fear, and fear can actually feel like pain.
Let me tell you an interesting story from the book. A construction worker stepped on a nail. It went all the way through his boot, the pain was intense, he screamed and his coworkers rushed him to the hospital. When the doctors cut off his boot, they discovered that the nail hadn’t touched his foot at all — it had slipped between his toes without penetrating the skin. But here’s the thing, the pain he felt was REAL. And that’s because the fear, perception of danger, and pain pathways in the nervous system all overlap.
Research shows that when people expect pain, brain areas involved in threat and fear become more active, and this changes how painful stimuli are processed. For example, in experiments where participants learn that one signal predicts an unpleasant stimulus, the brain shows increased activity in regions like the insula and prefrontal cortex before the stimulus arrives — and people report more intense pain when they expect it.
Why this matters
Modern neuroscience reveals that pain is a complex brain process, not a simple body signal. The brain has 44 different regions involved in pain processing, and these can get wired to interpret pain signals in an unhelpful way.
What this means is that pain isn’t just a direct result of physical sensory input — the brain interprets danger and then produces the experience of pain. Expectations, anxiety, and fear can amplify or even generate pain, while reducing fear can lessen pain responses.
So neuroplastic pain is when the nervous system gets wired to perceive more danger, which makes it feel more pain, which makes it perceive more danger and it gets stuck in a loop of constantly escalating pain.
Whether or not the pain was initially caused by a physical injury, when we add these 4 mentalities that increase your perception of danger, they tell your brain to dial up the pain.
- Meaning making: This pain is because of my bulging discs, what if it never goes away? What if I can’t work?
- Fear: Worry, pressuring yourself, self-criticism, hypervigilance.
- Conditioning: In the same way that vomiting after eating a certain type of food will cause you to avoid that food in the future (even if it was triggered by the stomach flu), your brain can also make true or false associations with pain. For example, “If I sit in that chair, it makes my back hurt.”
- Avoidance behaviors: I made like 30 videos on this for the anxiety course. In the context of chronic pain, when you feel like your pain is going to be bad, you might avoid it by using heating pads or changing your position, or avoiding situations. And when you’ve avoided the thing, and you didn’t die, that avoidance behavior reinforces to your brain that the pain is dangerous, and then your brain actually dials up the anxiety or pain.
Do you see how pain can get stuck in the nervous system? It’s important to understand that because you can’t address neuroplastic pain by fixing the body through surgery or other physical means. In the same way that trauma or threat can get your nervous system stuck on high alert, which can result in chronic anxiety, fear around being in pain can also get your nervous system stuck on high alert, resulting in chronic pain. And you have to address that in the brain.
Alan Gordon says,
“I still have bulging discs. I still have high cerebrospinal fluid pressure. I probably still have a partially torn rotator cuff. But I don’t have any pain. I eliminated all twenty-two of my symptoms.”
Neuroplastic Pain Indicators
So if all pain feels like it’s coming from the body, how do you know if your pain might be neuroplastic?
In the appendix (4. Alan Gordon and Alon Ziv, The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain (New York: Avery, 2021), pp. 163-168.) of The Way Out book, Alan shares 12 guidelines that can help you determine if your pain is neuroplastic. And I’ve added one of my own to the list.
- The pain began during a time of stress.
- The pain originated without injury. Or, if you had a physical injury but the pain persists after the injury heals, it has probably become neuroplastic.
- The painful symptoms are inconsistent. It might seem like the pain always starts when you walk, or drive, or it happens on workdays. But when you track it (which we’re getting to), you might discover that the pain isn’t 100% consistent with those triggers.
- A large number of symptoms. If you don’t have multiple sclerosis or another systemic disorder, it is highly improbable that you would have three or more unrelated physical conditions—unless neuroplastic pain underlies at least some of it.
- Symptoms spread or move.
- Symptoms are triggered by stress.
- The pain is triggered by things outside the body. For example, if your pain is worse around your mother-in-law, that points to it being a neuroplastic, conditioned response.
- Symmetrical symptoms. When you develop pain on both sides of the body that’s not connected to an injury
- Delayed pain. If your pain starts up after the trigger, instead of during the activity.
- Certain personality traits. Traits like self-criticism, worry, perfectionism, conscientiousness, people-pleasing, and anxiousness can all put the brain on high alert.
- Lack of a physical diagnosis. If doctors can’t find anything wrong, that’s a good indication that your pain, which is real, might be neuroplastic and not structural. And even if you do have a physical diagnosis, it might not actually be causing all your pain.
- Childhood adversity. Children who experience trauma are more likely to have chronic pain in adulthood. This includes “big” trauma like repeated physical or sexual abuse, or something less dramatic that made you feel unsafe, such as an anxious or depressed parent. Anything that made the world seem like a dangerous place can make your brain more likely to develop neuroplastic pain.
- The pain is attached to high stakes. For example, if you’re a pianist, and you develop wrist pain, that’s going to trigger more fear because it’s connected to something that’s super important to you.
This list was eye opening for my project manager and editor, Mary, who introduced me to the book. She began experiencing upper and lower back pain that checked the boxes of all but three of these indicators. AND, when she put into practice what Alan teaches for reshaping her relationship to this pain, she very quickly found relief. Here’s her experience:
Mary: “Hi Emma! So yeah, three years ago my daughter got engaged and she had a 9-week lead time before the wedding, and I was stressed! Within a few days of her engagement I got almost-constant pain in my shoulder and lower back. It seemed to get worse if I sat too long or stood too long. The pain stuck around for 32 months even though I tried all sorts of things to fix it: massage, a chiropractor, PRP injections, acupuncture, physical therapy, exercise equipment, a new office chair. I spent $4,377.57. Then I listened to this audiobook that was free from the library. I tried Alan’s somatic tracking meditation, and after doing it three days in a row, my pain was down to about 20% of what it had been. I now do the somatic tracking for 5 minutes every morning, and if the pain pops up during the day, which happens a few times each week, I pause and give 30 seconds of curious attention, and it almost always disappears.
She convinced me to read the book and now I’m convinced as well.
If you need more convincing, I’m putting together a Chronic Pain video playlist. I got to interview Alan Gordon and he shared his somatic tracking exercise.
Chronic Pain Management: 3 Barriers to Healing Neuroplastic Pain
Before I get to the techniques for turning down the pain, we need to address three good reasons that you will want to remain convinced that your pain has to be coming from your body. Alan Gordon calls these barriers, and we have to get past them if we’re going to successfully address the pain neurologically.
(1) The first barrier is that physical pain serves the important purpose of helping us not exacerbate a real injury. So when we feel pain, the natural conclusion is that some physical problem must be causing it. It takes a little effort to teach the brain that pain can be a false alarm, so we have to create space to entertain the possibility that chronic pain can be treated in non-physical ways.
(2) Second, we may have formed a conditioned response that results in pain. For example, Alan’s brain formed a conditioned response to sitting. Within moments of sitting, his back was in pain. Hard and short chairs were worse for him than soft or tall chairs. But the chairs weren’t causing the pain. His brain made the incorrect connection that sitting was a dangerous activity, and the pain started up as soon as he sat.
(3) Okay, the third barrier—and this is a big one— is medical diagnosis. Doctors are experts, right? Well, yes, they are experts in looking for structural causes of pain. And when you look for a structural issue, you will probably find one, even if it’s not the root cause of the pain.
Many people with chronic pain are given a structural diagnosis — like bulging discs, disc degeneration, arthritis, or “wear and tear.” Once they have that label, every sensation gets interpreted through it: “My back hurts because my discs are damaged.”
The problem is that this interpretation often doesn’t match what we know from research. Large imaging studies consistently show that:
- A huge percentage of pain-free people have bulging discs, herniations, degeneration, or arthritis.
- These findings increase with age, even in people with zero pain.
- Structural abnormalities are often incidental, not pathological.
So we end up with a paradox:
- One person has bulging discs and no pain.
- Another has the same imaging and severe, persistent pain.
This tells us something important: The structure alone can’t explain the pain. But the diagnosis can fuel chronic pain. Once someone is told by a doctor, “Your back pain is caused by bulging discs,” several things happen neurologically.
The Danger-Pain Cycle of Neuroplastic Pain
- The brain assigns threat
The diagnosis sounds dangerous.
- “My spine is damaged.”
- “I’m going to have this for life, and I just have to endure it.”
- “I could make it worse.”
- “I need to protect my back.”
By now it should be no surprise that these scary messages activate fear and threat circuits in the brain.
- The brain becomes hypervigilant
Normal sensations — stiffness, muscle fatigue, tension — are now scanned constantly:
- “Is this my disc?”
- “Did I injure myself more?”
- “Should I stop moving?”
This attention + fear amplifies pain signals. Over time, the brain learns that movement = danger, and you develop a conditioned response that keeps your pain active.
- Pain becomes predictive, not reactive
This is neuroplastic pain: the brain produces pain to protect you — even when there’s no new injury. This isn’t imagined or “in your head.” The pain is real. The brain regions lighting up are real. The suffering is real. But the source isn’t ongoing tissue damage — it’s a learned danger signal reinforced by the diagnosis and fear-based interpretation.
When an expert says something is wrong with your body, it can be very difficult to want to try a mind-based approach. But guess what? It’s a lot less expensive and less invasive to give these techniques a try than it is to take drugs or undergo surgery that may or may not work. If your brain is stuck on processing danger signals, what do you have to lose to teach your brain that you’re safe?
And of course I recommend that you read Alan Gordon’s book, The Way Out. It goes into much more detail than I can put in this post.
7 Pain Reprocessing Therapy Techniques to Turn Off Neuroplastic Pain
Because chronic neuroplastic pain happens when the brain is in a constant high-alert state, we need to address it by helping the brain to feel safe and calm. The Way Out by Alan Gordon teaches several techniques for doing that, and of course, I recommend reading the book to get a much more thorough explanation. The very first one will knock out those three barriers I just mentioned.
Okay, here’s how you can help your brain calm down and release the pain.
1. Make an evidence journal
To convince your smart, thinking brain that it might be getting something wrong about your pain, you need to give it evidence.
One type of evidence is to watch for exceptions. For example, if your back starts aching when you sit, but you make it all the way through a thrilling movie or sports event without pain, that’s an encouraging exception. It means that your brain was distracted from the deep-down fear that normally fuels your pain. Write that down in your phone or journal.
To find other evidence, go back to that list of 13 guidelines. Add to your journal any notes that align with that list. For example, when your pain comes on, notice and note your stress level. You may find a correlation. Or think about when your symptoms first started. Did they come out of nowhere, like Mary’s did when her daughter got engaged?
If you note just a few pieces of evidence, it is likely that your pain is neuroplastic. Which is good news!
2. Practice somatic tracking
If you do only one of the techniques, do this one. In fact, it’s such a key part of Pain Reprocessing Therapy that I’m making a separate video of this guided practice so you can come back to it quickly until you get the hang of it for yourself.
In a nutshell, somatic tracking is intentional mindfulness of your pain. You get grounded, notice the sensation of your pain without judgment, and get curious about it. Just watch the pain like you’re watching the colors of a sunset change. Observe it without catastrophizing. Maybe it’s tight or tingling or pinching. You notice if the pain changes or moves to another part of the body, or maybe it dissipates. The whole practice can be done in a matter of minutes. For patients whose brains are on super high alert, Alan usually starts with just a few seconds of mindfulness.
Interestingly, the aim of this practice is not to get rid of the pain. Here’s why. When we approach pain with the belief that it’s bad, we tell the brain that pain is scary, and so the brain essentially reacts with, “See? I knew pain was scary. Right here, do you feel how scary that is?” And the pain continues. But on the other hand, mindfulness deactivates the brain’s fear circuits. When you repeatedly practice curious mindfulness about the pain, the brain learns that your body is actually safe, and eventually it will stop overreacting to whatever neutral signals it picks up in the body.
Reinforcing safety is key to Pain Reprocessing Therapy, which will take us to #4, but first I’ve got to give you #3.
3. Use avoidance behaviors wisely
A few minutes ago I told you how avoidance can fuel anxiety and pain. Usually avoidance keeps us stuck because it lets us escape our fear instead of facing it safely. But Alan points out that occasional avoidance behaviors can be an effective tool for overcoming fear. Here’s what he said in the book:
“Avoidance behaviors are really common with chronic pain patients. Anything you do to reduce your pain (or to keep from triggering it in the first place) is an avoidance behavior…When you have high levels of pain, your brain is feeling a lot of danger. That means it’s pretty much impossible to have a corrective experience. So we’re not even going to attempt somatic tracking…If you have to use a pillow or a hot-water bottle or massage the body part that hurts, do it!…When your pain is high, you want to engage in avoidance behaviors.” [Alan Gordon, The Way Out]
I think what he’s saying is, when we work on our pain or anxiety, we want to keep it within our window of tolerance. We can’t just force ourselves to learn how to swim by jumping in at the deep end. Be gentle with yourself and keep yourself in the growth zone, not the high-alert panic zone.
These next few techniques are used mostly to take our brain off constant high alert. Here’s #4.
4. Give your brain messages of safety
Neuroplastic pain a fear response, you’re going to calm your brain with messages of safety when it gives you a high-pain experience:
- “This sensation is temporary. I’m going to be fine.”
- “My body is okay and I am safe.”
- “This pain is just a false alarm because my brain thinks I’m in danger.”
If we want to interrupt the pain-stress-pain cycle, and help our brains feel safe, we also need to manage our overall stress levels. We can do this by decreasing notifications on our phones, multitasking less, and taking time to slow down.
5. Handle uncertainty: “It’s going to be okay.”
Another way that we keep our brain on high alert is by trying to control uncertainty by worrying. If you have a big decision to make, or you’re not sure how something will turn out for a loved one, ruminating on the problem can convince your brain that the stakes are super high and everything will fall apart if you make the wrong decision.
When you’re in a place of uncertainty, you can give yourself another message of safety: “Whatever happens, it’s going to be okay.”
Okay, two more to go.
6. Catch your fears
Alan Gordon identifies three thinking patterns that he sees in the majority of his chronic pain patients.
- Worry is the fuel of anxiety
- Pressure: “I have to make this pain stop or else!”
- Self-criticism fuels the idea that there’s something wrong with you, and that keeps fear high.
And I’ll add
- Hypervigilance is when you’re constantly scanning for any signs of the next pain period.
These fears keep the brain on high alert, which makes your pain worse. These automatic thoughts are going to pop up, but there are three things you can do:
- Notice the thought.
- Let the thought go without buying into it.
- Replace that fear thought with one of the messages of safety I covered in technique #4.
Okay, there’s one more technique to help your brain not send the wrong signals about pain. This one’s a good one!
7. Embrace positive sensations in the body
Just as we’re going to replace automatic negative thoughts with messages of safety, we’re going to strengthen the neural pathways for positive sensations by seeking out things that feel good. Create some kind of practice, whether it’s a reminder on your phone or a meditative body scan, to look for positive or pleasant sensations and break the cycle of constantly scanning for pain.
Maybe you bask in the feeling of warm water sprinkling your skin in the shower. Or you close your eyes and think about the flavor and texture of your food. Or go for a walk and enjoy the breeze in your hair, the warm sunshine on your skin.
Just like anything you practice, embracing positive sensations gets easier as you do it often. And embracing positive sensations will help you make peace with your body so you can see it as your friend.
Reprocessing Neuroplastic Pain is a Process
Before we wrap up, I want to prepare you for setbacks.
Alan says that just about everybody who starts this pain reprocessing process will experience relief—and then they will relapse. And that relapse is scary because when your pain comes back, you are desperate to be free of it. But you have to trust the process.
A relapse is part of the process, so when it happens, just remind yourself, “Oh yeah, I knew this was coming. Here it is, and I can work through it.”
Keep doing the 7 techniques. After more repetition, you’ll drop that desperate energy and add back in positive, curious energy, and it will all click for you again. AND, you will have strengthened your resilience.
I really am hopeful that Alan’s process will heal or reduce chronic pain if you’ll give it a chance. If you try it for a month or more, please come back here or go to my Chronic Pain playlist and comment to let this audience know what changed for you. And if you’d like individualized help, you can contact the Pain Psychology Center.
If you have stress, PTSD, or anxiety in your life, and you’d like more practice with turning on the calming part of your nervous system, I encourage you to check out a course I developed: Grounding Skills for Anxiety. It’s free to access, and you’ll get 15 simple lessons to help you feel more calm in your body.
