Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain an RCT, 2021, Asher, Gordon et al

Grigor said:
I'm not sure if this needs a separate thread so I'm posting it here. A critical article about PRT being hyped in the Norwegian media and elsewhere.

www.psykologtidsskriftet.no

Når mål om smertefrihet møter klinisk kompleksitet

Pain reprocessing therapy lanseres som en banebrytende smertebehandling, men evidensgrunnlaget er tynt, og det er lite nytt å spore i tilnæ…
www.psykologtidsskriftet.no www.psykologtidsskriftet.no
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Very interesting, thanks for posting!

Here’s a English translation via Google Translate:
translate.google.com

Når mål om smertefrihet møter klinisk kompleksitet

Pain reprocessing therapy lanseres som en banebrytende smertebehandling, men evidensgrunnlaget er tynt, og det er lite nytt å spore i tilnæ…
translate.google.com translate.google.com
 
Not a terrible article, but it's clearly in denial of the state of things, and in fact represents the state of things as well as any of the nonsense coming out of extremists. They talk of how there are decades of small, low-quality trials for all sorts of stuff like CBT, ACT and so on, but think it's fine because since the evidence is lousy anyway, it's better to have many options as most treatments won't work for most people (that's an understatement).

Then they mention how there has been only one small, low-quality trial of PRT, and how it warrants caution, also because targeting "one type of pain" (nociplastic) is a problem. But this is exactly the evidence base they opened with as a good thing. It shows how all it takes for lousy nonsense to become accepted is just time and quantity. As long as it's been around for a long-enough time, all it takes is dozens of lousy trials for a bad idea to become good enough for them. Give this PRT 1-2 decades and a dozen or so pilot/feasibility trials and they'll sign its praise, same as all the others.
Modulating mechanisms for pain in the central nervous system have been known and integrated into treatment for a long time (Thorn, 2020). The introduction of the concept of nociplastic pain is based on many decades of research.
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It's recently been given that name, but the idea underpins the entire psychobehavioral approach. So, it's not true that there is only one small, low-quality trial of this, because it's mostly identical to all other others. They differ about as much as one expensive shaken water bottle differs from another. There have easily been hundreds already. The entire discipline appears to be in complete denial of where it's at, where it's been, and clearly has no idea where it's heading, which is the same downward spiral that's captured it long ago.

Things are not about to change here. In fact this is just more of the same as before, which itself was more of the same as before. It might be that they genuinely don't notice that all of this is just a cycle of recycling and rebranding, but that's just as worrying as the alternative. Everything that clinical psychology touches seems to suffer from the same outcome: stagnation. Things enter this space, but they never leave it, bouncing around an echo chamber that is perfectly capable of perpetual motion of the same idea.
 
www.sciencenorway.no

Is the new PRT method for chronic pain really a miracle cure?

'Enormous potential,' say some experts. “The techniques are well known and have been used for many years, with fairly small effects,” say others.
www.sciencenorway.no www.sciencenorway.no

Is the new PRT method for chronic pain really a miracle cure?​

"Enormous potential," say some experts. “The techniques are well known and have been used for many years, with fairly small effects,” say others.

PUBLISHED 3 August 2026


The Norwegian VGTV series Harald og sytepavene (Harald and the Whiners) is about six people with long-term chronic pain who suddenly recover. After just a few weeks of treatment aimed at reprogramming the brain's perception of pain, all of them are either much better or completely pain-free.

It seems like a miracle. One person who has experienced this kind of radical improvement is comedian and TV host Einar Tørnquist, as he told Science Norway.

The potential is enormous, say psychologist Silje Endresen Reme and physician Andreas Pahle, the experts featured in the TV programme.
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“It's absolutely true that several of the techniques are already well known,” Reme tells Science Norway.
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The biggest difference for patients may be what the therapist tells them about their chances of recovery, according to the professor.
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Trydal fears that unrealistic expectations can easily turn hope into despair.

“I have worked in this field for a long time, and patients do sometimes become pain-free, but for it to happen for so many and in such a short time as shown in the TV series is unrealistic. I find it almost unethical to create those kinds of expectation,” she says.

In an email to Science Norway, Tommy Gulliksen from Dox Division, the production company behind the VGTV series, writes:

“What is the basis for that claim? It is entirely legitimate to ask critical questions about the results, but to call something ‘almost unethical’ is a serious accusation that should be supported with stronger evidence than this.”
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“But I'm not so afraid of hype. If there's one thing our field and our patients have had too little of, it's hype and enthusiasm,” says Reme, adding:

“Patients with chronic pain have not been the subject of much positivity and optimism, whether from the medical community, the media or society in general. We've probably been too afraid of giving false hope. I think there's a greater risk of causing harm by fuelling hopelessness.”

She believes that the sense of safety and hope of recovery itself contributes to the process of changing the brain's perception of pain.
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The Norwegian comedian Einar Tørnquist experienced significant improvement from PRT himself. But he doesn't think it would have been too harmful if the treatment didn't work for him.

“When I was at my lowest, there were only disappointments. I kept having hopes for a new injection, a new treatment, or a new exercise that never worked. At worst, this would simply have been one more thing that didn't help,” says Tørnquist.

“We're not talking about surgery or medication here. You risk almost nothing by trying this. So I think it's reasonable to give it a chance. There are stories of people who have begged for and been granted amputations because of chronic pain. You should at least be able to give them a little chat with a psychologist,” he adds.
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Reme believes the VGTV series has had a major impact.

“After an important research finding is published, it typically takes between 10 and 15 years before it is put into practice,” she says.

She believes the extensive media coverage has dramatically shortened that timeline in Norway.

“I used to think it was enough to conduct solid research and publish it in good journals, and then the findings would automatically benefit patients and the field. Now I understand that the world doesn't work like that. The media and broad public communication play a large and important role in getting things out quickly, and in changing healthcare practices, as we're seeing now,” says Reme.
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She has often wondered why not everyone sees the same potential in the treatment as she does.

“I think you have to experience it yourself. I've never seen anything like this. When you first meet a patient who says: ‘The pain is actually gone. I no longer have chronic pain,’ it changes you – both as a person and as a therapist,” she says.
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Chandelier said:
www.sciencenorway.no

Is the new PRT method for chronic pain really a miracle cure?

'Enormous potential,' say some experts. “The techniques are well known and have been used for many years, with fairly small effects,” say others.
www.sciencenorway.no www.sciencenorway.no

Is the new PRT method for chronic pain really a miracle cure?​

"Enormous potential," say some experts. “The techniques are well known and have been used for many years, with fairly small effects,” say others.

PUBLISHED 3 August 2026
Click to expand...

So Professor of Health Psychology and Lightning Process fan Silje Endresen Reme wants Healthcare Practices to be rapidly changed via Media influence. Sounds like she advocates bypassing high quality research, and wants to influence the public perception and health policy directly by media stunts.

That's utterly mind-boggling. But in line with the emerging trend for Pop Medicine by soundbite and meme.

“I used to think it was enough to conduct solid research and publish it in good journals, and then the findings would automatically benefit patients and the field. Now I understand that the world doesn't work like that. The media and broad public communication play a large and important role in getting things out quickly, and in changing healthcare practices, as we're seeing now,” says Reme.
Click to expand...
 
I used to think it was enough to conduct solid research and publish it in good journals, and then the findings would automatically benefit patients and the field. Now I understand that the world doesn't work like that.

But does she not agree that the world should work like that?
And that if there is no solid research you are just selling quackery?

And in rheumatology it always has worked like that. As soon as solid research is published, physicians have become aware of it at scientific meetings and made use of it.

Something is missing from the analysis!
 
5 years on this PRT study remains unreplicated. The original investigators had very strong allegiance to the therapy (very common bias in trials of psychotherapy) so in order for this to have any credibility I would need to see it repeated elsewhere.
 
Jonathan Edwards said:
I used to think it was enough to conduct solid research and publish it in good journals, and then the findings would automatically benefit patients and the field. Now I understand that the world doesn't work like that.

But does she not agree that the world should work like that?
And that if there is no solid research you are just selling quackery?

And in rheumatology it always has worked like that. As soon as solid research is published, physicians have become aware of it at scientific meetings and made use of it.

Something is missing from the analysis!
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It seems like she has experienced that her «good research» didn’t get the uptake she wanted, so they are now trying pure marketing (i.e. propaganda) instead.

As you say, the flaw in the analysis is probably assuming the research was good in the first place..
 
Btw, Alan Gordon was interviewed on Raelan Agle's youtube channel a couple of days ago. He goes over an actual PRT practice session in the interview so you can see what's involved. (Usually, these mind-body programmes are behind paywalls and surrounded by secrecy.)

 
Sid said:
Btw, Alan Gordon was interviewed on Raelan Agle's youtube channel a couple of days ago. He goes over an actual PRT practice session in the interview so you can see what's involved. (Usually, these mind-body programmes are behind paywalls and surrounded by secrecy.)

Click to expand...

Quick, there’s a discount on the e-book – and there‘s only a couple of days left!!!!!!

On a more serious note – nah, who am kidding – look at these timestamps:

TIME STAMPS:
00:00 - Pain, Fatigue, Anxiety: One Mechanism
00:22The Book This Channel Quotes Most
01:56 ? "But My Symptom Isn't Pain"
04:17A 900-Patient ME/CFS Study
05:32Agony From an Injury That Wasn't
06:29Trapped in Fight or Flight
07:35 O 3 Habits That Predict Symptoms
09:39IF A 4-Inch Binder of Diagnoses
10:53Same Back, Four Different Diagnoses
12:06The Book He Threw Across the Room
12:52"This Can't Be Me... Right?"
13:4298% Think They're the 2%
15:03? How Many Are Actually Neuroplastic?
17:22"90% Is an Undershoot"
17:4230 Years of Pain, Gone in a Week
19:07When Alan Got the Fatigue
21:27Okay - So What Do You DO?
23:28Live Somatic Tracking With Its Creator
27:06Louder Doesn't Mean Worse
33:30Still a 3/10 - But It Feels Nice?
35:10The Experiences That Rewire You
36:42What If You Get Trapped?
39:05Talk to Your Brain Like a Baby
40:53C. The Way Out for $1.99
41:49One-on-One Help From Alan's Team
42:27The Story That Proves It Works

Direct link to the somatic tracking session.

Btw, if you have unexplained pain AND fatigue, Alan thinks chances are way higher than 90% that it’s neuroplastic or whatever.
 
Chandelier said:
Quick, there’s a discount on the e-book – and there‘s only a couple of days left!!!!!!

On a more serious note – nah, who am kidding – look at these timestamps:

TIME STAMPS:
00:00 - Pain, Fatigue, Anxiety: One Mechanism
00:22The Book This Channel Quotes Most
01:56 ? "But My Symptom Isn't Pain"
04:17A 900-Patient ME/CFS Study
05:32Agony From an Injury That Wasn't
06:29Trapped in Fight or Flight
07:35 O 3 Habits That Predict Symptoms
09:39IF A 4-Inch Binder of Diagnoses
10:53Same Back, Four Different Diagnoses
12:06The Book He Threw Across the Room
12:52"This Can't Be Me... Right?"
13:4298% Think They're the 2%
15:03? How Many Are Actually Neuroplastic?
17:22"90% Is an Undershoot"
17:4230 Years of Pain, Gone in a Week
19:07When Alan Got the Fatigue
21:27Okay - So What Do You DO?
23:28Live Somatic Tracking With Its Creator
27:06Louder Doesn't Mean Worse
33:30Still a 3/10 - But It Feels Nice?
35:10The Experiences That Rewire You
36:42What If You Get Trapped?
39:05Talk to Your Brain Like a Baby
40:53C. The Way Out for $1.99
41:49One-on-One Help From Alan's Team
42:27The Story That Proves It Works

Direct link to the somatic tracking session.

Btw, if you have unexplained pain AND fatigue, Alan thinks chances are way higher than 90% that it’s neuroplastic or whatever.
Click to expand...
Starting at 33:30:


Yeah. So, a very funny story.​
Um, I was doing a session with someone in the Boulder Back Pain study and we were doing an exercise like that and uh, you know, before we did I said, "What is what are your symptoms right now?" She's like, "It's like a a three out of 10 in my back and it's this like warm kind of burny feeling."​
I did a somatic tracking exercise with her and at the end she opened her eyes and she said, "This is so funny. It's still a three out of 10, but it kind of feels nice now.​
So, the intensity, the severity of the sensation didn't change at all.​
The only thing that changed is her appraisal of it.​
And I started feeling this way with my back at one point where I was doing somatic tracking and I would think there's still this like grindy feeling that I'm feeling in my back, but instead of being unpleasant, instead of being bothersome, it felt kind of nice.​
And so that I think for a lot of people is there's a feeling of the sensation needs to go down in order for this to be working in order for me to be progressing.​
But it's not about a change in the intensity.​
It's about a change in the way that you're paying attention to it.​
If your brain is attending to a sensation through a lens of danger, it'll be processed as unpleasant.​
If you're attending to a sensation through a lens of safety, it will be pleasant or or neutral.​
So, it's about changing that energy.​
Does that make sense?​

 
Chandelier said:
Direct link to the somatic tracking session.
Click to expand...

From the Somatic Tracking session:


Whether it's the air coming in and out of your nostrils or whether it's the feeling of the air rustling against the inner lining of your lungs, if it's natural for you to focus on your chest, or if it's the air rustling against the inner lining of your stomach and that's where you want to focus on it.

I was once doing this meditation with a​
gastroentererologist and I made that comment and he said he opened his eyes abruptly and he said it's the diaphragm not the stomach.​


I don’t know about you, but I deem Alan safe to be around other people, particularly patients. :thumbup:
 
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