What Is Somatic Tracking? The Core Skill of Pain Reprocessing Therapy

If you’ve been researching Pain Reprocessing Therapy — or your doctor mentioned “neuroplastic pain” and sent you down a rabbit hole — you’ve probably run into the term somatic tracking. It gets described in ways that sound either suspiciously simple (“just observe your pain!”) or frustratingly vague (“attend to sensations mindfully”).

As a therapist who practices PRT, and as someone who lives with chronic illness myself, I want to give you the honest version: what somatic tracking actually is, why it works when it works, and — because this matters just as much — when it’s the wrong tool.

What somatic tracking actually is

Somatic tracking is the central technique of Pain Reprocessing Therapy (PRT), developed by therapist Alan Gordon of the Pain Psychology Center and described in his book The Way Out.

In plain language: somatic tracking means paying attention to a pain sensation while deliberately holding a sense of safety, curiosity, and even lightness — instead of the fear, dread, and bracing that pain usually pulls out of us.

That’s it. You’re not visualizing the pain away. You’re not breathing it out. You’re not distracting yourself from it. You’re doing almost the opposite: turning toward the sensation and watching it the way you might watch clouds move — with genuine curiosity and no agenda.

Which raises the obvious question: how could that possibly help?

Why it works: pain is a danger signal

Here’s the piece most of us were never told. Pain isn’t a direct readout of tissue damage. Pain is your brain’s interpretation — an alarm it produces when it concludes the body is in danger.

Usually that alarm is accurate and useful. But the brain can learn pain. After an injury heals — or sometimes with no injury at all — pain circuits can stay switched on, reinforced every time we respond with fear. Gordon calls this kind of pain a “false alarm”: real pain, genuinely felt, generated by an overprotective brain rather than by ongoing damage. The clinical term is neuroplastic pain.

And fear is the fuel. When pain shows up and we tense, panic, catastrophize, or monitor it anxiously, we confirm the brain’s prediction that something dangerous is happening — so the alarm keeps sounding. Pain leads to fear leads to more pain. Many of us have lived in that loop for years without anyone naming it.

Somatic tracking interrupts the loop at its hinge point. By attending to the sensation through a lens of safety, you send the brain new evidence: I’m looking directly at this, and nothing terrible is happening. Over time, the brain updates its prediction, and the alarm — the pain — can genuinely quiet down.

This isn’t wishful thinking. In the 2021 Boulder Back Pain Study, published in JAMA Psychiatry (Ashar and colleagues), 66% of people with chronic back pain were pain-free or nearly pain-free after four weeks of PRT — compared to 20% with placebo and 10% with usual care — and most maintained those gains a year later. For a chronic pain treatment, those are remarkable numbers.

What a somatic tracking practice looks like

I’m deliberately not going to hand you a script here — this is a skill best learned with guidance, and the how matters more than the steps. But loosely, a practice looks something like this:

You settle somewhere comfortable, at a time when your pain is present but mild. You bring gentle attention to the sensation — where it sits, what qualities it has. Tight? Warm? Buzzing? Does it have edges? Does it shift?

While you observe, you remind yourself of what’s actually true: this sensation is uncomfortable, but it isn’t dangerous. My body is okay. My brain is being overprotective.

And you keep the whole thing light. If it starts feeling like grim, white-knuckled concentration, you’ve drifted out of somatic tracking and into vigilance — which is the very thing we’re unlearning. A few minutes is plenty. Then you go back to your day.

Simple to describe. Genuinely tricky to do well, which brings me to the mistakes.

The mistakes that make somatic tracking backfire

Using it to make the pain go away. This is the big one, and almost everyone does it at first — I certainly did. If you’re tracking while secretly monitoring whether it’s working, you’ve turned the practice into outcome pressure. Your brain reads that pressure as more evidence of threat, and the alarm stays on. The paradox at the heart of this work: relief comes as a side effect of genuine safety, not as a goal you can grip.

Tracking during a high-intensity flare. When pain is at an 8, your nervous system is not in a state where curiosity is available — and trying to force it usually deepens the fear. Somatic tracking is for low-to-moderate sensations. During big flares, the skill is different: comfort, soothing, and riding it out with as much self-compassion as you can find.

Using it for pain that’s structurally driven. Somatic tracking is for neuroplastic pain. If your pain is coming from an active injury, infection, inflammation, or a condition that needs medical treatment, telling your brain “this is a false alarm” isn’t just unhelpful — it’s inaccurate, and it can delay care you need. This is why proper assessment comes first, ideally with both your medical team and a therapist trained to recognize neuroplastic pain patterns.

Who it’s for — and who should be cautious

Somatic tracking is a good fit when pain has neuroplastic features: it outlasted an injury, moves around, varies with stress or attention, started without clear damage, or persists after doctors have found nothing structural to explain it. Chronic back pain, tension headaches, many cases of fibromyalgia and pelvic pain — these frequently have a neuroplastic component.

And here’s where I’ll be more careful than a lot of what you’ll read online.

If you live with ME/CFS or experience post-exertional malaise (PEM), please hear me: any approach that even whiffs of “your symptoms are a false alarm, push through” can cause real harm in your body. Crashes are physiological. Pacing comes first — always. In my practice, brain retraining tools are never a replacement for respecting your energy envelope, and I don’t use somatic tracking to talk anyone out of symptoms that require accommodation. If a program has ever made you feel that crashing was your fault for “fearing your symptoms,” that wasn’t good care, and I’m sorry it happened.

The nuance is this: a person can have a structural or physiological condition and a layer of neuroplastic pain on top of it. Untangling which is which — gently, without gaslighting your body — is exactly the work of good PRT.

Learning it properly

You can absolutely read The Way Out and experiment on your own; many people do. But in my experience, the difference between somatic tracking that works and somatic tracking that becomes another anxious ritual usually comes down to guidance.

That’s why I built my self-paced Pain Reprocessing Therapy course — psychoeducation, practice, and the common pitfalls, in a format you can move through at your body’s pace. And for people who want individual support, I offer 1:1 chronic pain therapy informed by PRT, online across BC, where we can sort out together whether your pain fits the neuroplastic picture and tailor the work to your actual life and diagnoses.

If you’re not sure where to start, you’re welcome to book a free 20-minute consult. Bring your complicated chart. I have one too.

FAQ

What is somatic tracking in simple terms? Somatic tracking is paying attention to a pain sensation with curiosity and a felt sense of safety instead of fear. It’s the core technique of Pain Reprocessing Therapy, and it works by teaching your brain that the sensation isn’t dangerous, which allows learned pain to fade.

Is somatic tracking the same as mindfulness? It’s related but not identical. Somatic tracking combines mindful attention with two additions: actively reappraising the sensation as safe, and bringing a quality of lightness or positive emotion to the practice. Plain mindfulness observes neutrally; somatic tracking deliberately reframes.

How long does somatic tracking take to work? It varies widely. In the Boulder Back Pain Study, PRT was delivered over four weeks with strong results, but real life is less tidy — some people notice shifts quickly, others need months of practice alongside other work like addressing fear, stress, and old self-pressure patterns. Slower isn’t failing.

Can somatic tracking make pain worse? Done with outcome pressure, during intense flares, or for structurally driven pain, it can increase distress — which is why guidance and proper assessment matter. Done well, at the right intensity, for the right kind of pain, it’s a gentle practice with a strong evidence base.

This post is for education and isn’t a substitute for medical or mental health care. New, worsening, or unexplained pain deserves medical assessment first. If you’re in BC and want support with chronic pain, I’d be glad to meet you.