Key Points
- Not all persistent pain requires surgery — some is driven by a sensitized nervous system that has learned to keep producing pain even after tissue healing.
- Mind-body approaches like pain reprocessing therapy have measurable effects: in a 2021 JAMA Psychiatry trial, two-thirds of participants with chronic back pain were pain-free or nearly pain-free at one-year follow-up.
- These resources complement — never replace — a thorough medical evaluation to rule out structural, treatable causes of pain.
Why I'm Writing This
As a peripheral nerve surgeon, my job is to identify the pain that surgery can fix — a compressed nerve, a scarred segment, a treatable structural problem. But I also see patients whose pain persists even after imaging is clean, EMGs are normal, and every reasonable structural explanation has been ruled out. For those patients, the answer is not another operation. It is understanding that pain itself can become the disease — and that pain has both a physical and a neurological dimension.
This post highlights three resources I sometimes recommend to patients whose pain has a significant central-sensitization or neuroplastic component. None of them replaces a proper medical workup. All of them can be a valuable addition once serious structural causes have been ruled out.
A Quick Reminder About Central Sensitization
What's happening
Central sensitization is what happens when your nervous system's pain "volume knob" gets stuck on high. After an injury, illness, or period of prolonged stress, the pain-processing pathways in the spinal cord and brain can become oversensitive — amplifying signals that should be quiet, and sometimes producing pain in the absence of any current injury.
The result: pain that feels very real (because it is real — the brain is genuinely generating a pain experience) but that isn't proportional to any current tissue damage. Standard pain treatments — including surgery — often don't help this kind of pain, because they aren't addressing the amplification.
If you have symptoms that persist despite a normal test, you may also find my post on nerve pain when EMG testing is normal helpful. A normal test does not by itself settle the question of what is causing pain.
Resource #1 — The Way Out by Alan Gordon
Resource #1
The Way Out by Alan Gordon
The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain is a 2021 book by psychotherapist Alan Gordon, founder of the Pain Psychology Center in Los Angeles and developer of Pain Reprocessing Therapy (PRT).
The book explains, in accessible language, why some pain persists long after tissue has healed — and introduces a specific set of techniques designed to help the brain reinterpret pain signals as safe rather than dangerous. The most well-known technique from the book is somatic tracking: a form of guided attention to pain sensations combined with reappraisal of what those sensations mean.
Key points
- Evidence: Gordon's methods were the subject of a 2021 randomized controlled trial published in JAMA Psychiatry in which two-thirds of participants with chronic back pain were pain-free or nearly pain-free at one-year follow-up.
- Who it may help: patients with chronic back pain, neck pain, fibromyalgia, tension headaches, or other pain conditions where a structural cause is unclear or where imaging findings don't match the severity of symptoms.
- Important caveat: PRT is designed for pain that is not being driven by active tissue damage. It is not appropriate as a first-line approach for pain caused by a treatable structural problem — which is exactly why a thorough surgical and medical evaluation matters first.
Resource #2 — Finding a Pain Psychologist or Pain Reprocessing Therapist
For patients who want to work with a trained clinician rather than a self-help book alone, several directories are worth knowing about:
American Association of Pain Psychology
A national, multidisciplinary directory of pain psychology providers. Founded in 2010, AAPP is one of the primary professional bodies in this field and maintains a public directory of members organized by location. Note: AAPP membership is not an endorsement of clinical competence, but it is a reasonable starting point for finding a practitioner in your area.
Pain Reprocessing Therapy Directory
A directory maintained by the Pain Reprocessing Therapy Center (co-founded by Alan Gordon). Providers listed here have completed formal PRT training. The directory covers medical providers, mental health clinicians, health coaches, and manual therapists.
Pain Psychology Center
The Los Angeles-based clinical practice where PRT was originally developed by Alan Gordon and colleagues. They specialize in the treatment of chronic pain via mind-body approaches, and offer both in-person and telehealth services within their licensed states. A good direct-access option for patients who want to work with practitioners closest to the source of the PRT method.
Practical tip: when calling a therapist to inquire, ask directly whether they treat neuroplastic or primary chronic pain, whether they use PRT, EAET (Emotional Awareness and Expression Therapy), or a comparable evidence-based approach, and whether they take your insurance or offer sliding-scale fees. Many pain psychology practices offer telehealth across state lines within their license, which expands your options significantly.
Resource #3 — PelvicSense (for Chronic Pelvic Pain)
Resource #3
PelvicSense
For patients with chronic pelvic pain — pudendal neuralgia, vulvodynia, chronic prostatitis / CPPS, interstitial cystitis, provoked vestibulodynia, and related conditions — PelvicSense is a self-paced, at-home program built specifically around pelvic-region neuroplastic pain.
PelvicSense was created by Evelyn Hecht, PT, a pelvic floor physical therapist with over 25 years of experience. The program combines pain neuroscience education, calming audio, breath work, gentle movement, and progressive core strengthening — delivered digitally over roughly a 3-month structured course.
The program was evaluated in a two-year independent study including participants with provoked vestibulodynia, endometriosis, and PGAD; the reported average reduction was 3 points on a 0–10 pain scale after 3 months of home use.
- Who it may help: patients with chronic pelvic pain lasting more than 3 months, after major structural or medical issues have been ruled out.
- How it fits: It is explicitly designed to complement — not replace — medical care and pelvic floor physical therapy.
- Note for veterans: PelvicSense is listed on the VA Market Research Database and may be available at no cost through the VA. Ask your VA provider to request access at VAPathfinderSupport@va.gov.
How These Fit Into a Comprehensive Approach
None of these resources are a substitute for a thorough evaluation. Here is how I think about the sequence:
- Rule out treatable structural causes first. This means a good history, exam, appropriate imaging, and — when relevant — nerve testing, diagnostic injections, or surgical consultation. If there is a compressed nerve, a scarred segment, or a fixable anatomic problem, that deserves to be addressed.
- If structural workup is negative, or if pain persists after appropriate treatment, consider whether central sensitization or neuroplastic pain may be playing a significant role.
- In parallel or as a next step, engage a resource that addresses the neurological dimension — a book, a therapist, or a program like the ones above. Many patients benefit most from a combined approach: continued medical care, physical therapy, and a mind-body program working together.
A Word of Honesty
Mind-body approaches to chronic pain are not magic, and they don't work for everyone. Some patients experience dramatic relief; others find modest improvement; some don't respond. What we know from the science is that they work better than nothing for many people with certain kinds of chronic pain, they have almost no downside risk, and they cost far less than another round of imaging or interventions that aren't going to help. That combination is why they're worth knowing about.
If you have chronic pain that has persisted despite reasonable medical care, it's worth having an honest conversation with your physician about whether central sensitization may be part of the picture — and whether one of these resources might be worth exploring.
Frequently Asked Questions
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If you have persistent pain that hasn't responded to standard treatment — or if you'd like to be evaluated to determine whether a surgical or mind-body approach is right for you — I'm happy to help.
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This article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Mention of external books, programs, or organizations is informational and does not represent a paid endorsement, financial relationship, or guarantee of results. Always consult your physician before starting any new treatment approach. Full disclaimer.
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