Chronic Pain Therapy That Draws From Pain Reprocessing Therapy (PRT)

If you've landed here searching for PRT in Canada, you've probably already tried a lot of things — physio, imaging, meds, maybe a pain clinic waitlist that stretches past any reasonable timeline. You're tired of being told to "just manage it." I get it. I'm Elysia, a Registered Clinical Counsellor who works with chronic pain and chronic illness, and my approach pulls heavily from Pain Reprocessing Therapy along with somatic work, pain neuroscience, and pacing. Sessions are online, across BC, Manitoba, and Saskatchewan.

So What Is PRT, Really?

PRT is a psychological framework for chronic primary pain — pain that persists after tissue has healed, or pain with no clear structural cause. Developed by Alan Gordon and researched at the University of Colorado Boulder, the 2021 randomized controlled trial in JAMA Psychiatry found that 66% of participants with chronic back pain were pain-free or nearly pain-free after four weeks of PRT, compared to 20% in the placebo group and 10% in usual care. PRT works by helping the brain re-evaluate pain signals that are no longer pointing to tissue damage. It is not brain retraining, positive thinking, or "pain is in your head." It is a clinical framework grounded in pain neuroscience.

PRT-informed work tends to fit people whose pain has become neuroplastic — meaning the wiring, not the wound, is doing most of the talking. That often looks like:
  • Chronic back, neck, or widespread pain with no clear structural explanation
  • Migraines and tension headaches that won't quit
  • Fibromyalgia and central sensitization
  • Pain that outlived the original injury by months or years
  • Pain that flares with stress, moves around, or changes shape
  • Pain tangled up with fatigue, brain fog, or medical trauma
If your pain is coming from active tissue damage, progressive disease, or something that needs medical intervention, this isn't a substitute for that.  And there are pain ranges that cognitive approaches don't help thus we only use PRT at a certain pain range as above that we use somatic approach as the body needs a different approach based on where your at. We work alongside your medical team, and along side you as you know your body best.

Who This Might Help:

What Sessions Actually Look Like

We meet online for 50 minutes, weekly or every other week. Sessions aren't me lecturing you on pain neuroscience (though there's some of that). Mostly we do somatic tracking — a skill I teach and we work to fit it to you. Here you're learning to notice what your pain is doing with curiosity instead of fear — along with work on the thought patterns, old stories, and nervous system states that keep pain stuck. If you've got chronic illness on top of chronic pain, pacing education is baked in to help shift fatigue. I will not ask you to push through a flare to prove something.

Why I Do This Work

I started pulling PRT into my practice because I watched too many chronic pain clients get handed coping strategies and sent home, as if that was the whole plan. PRT was the first thing I'd seen that treated chronic primary pain as a brain process rather than a character flaw — and had the data to back it up. I live with chronic illness myself, so I've also seen this stuff applied badly — pushed too hard, too fast, in the wrong nervous systems. That's why I combine it with pacing, somatic safety, and an explicit refusal to re-traumatize anyone in the name of "rewiring." This approach is a top down cognitive based approach and it doesn't fit everyone. We will work to find one that's better for you if this isn't it. Sometimes we need to start with a bottom up approach like Safe and Sound Protocol or Dialectical Behavioral Therapy.

How PRT Fits Into The Bigger Picture

Most of my clients don't use PRT-informed work alone. It shows up as a tool we use alongside the Safe and Sound Protocol for people whose nervous systems need to settle before any pain-focused work is safe. It shows up alongside pacing for clients with ME/CFS, POTS, or Long COVID. And it shows up alongside trauma-informed therapy for anyone whose pain is knotted up with medical gaslighting or misdiagnosis. We build the plan that fits you — not the other way around.

Questions People Actually Ask

Is this covered by insurance?
Sessions are billed under my RCC designation. Most extended health plans in Canada that reimburse RCC services will cover this — same as any counselling I do. ICBC and WorkSafe BC claims are also accepted. Check your plan for specifics before we start.

How is this different from CBT for chronic pain?
CBT for pain is mostly about coping — changing how you think about pain so it bothers you less. PRT-informed work aims to actually reduce or stop the pain by retraining the brain's response to signals that are no longer useful. It also leans harder into somatic and nervous system work.

Could this make my pain worse?
No. Done right, you should feel progressively safer in your body, not worse. If any therapy is cranking up your pain or distress, it's being misapplied — and that's on the therapist, not you. I move at the speed your nervous system can handle.

Do I need a doctor's referral?
Nope. Seeing a Registered Clinical Counsellor doesn't require a medical referral in BC, Manitoba, or Saskatchewan. I'll sometimes ask for your medical team's info so we can coordinate, but that's optional.

What if my pain has a known cause — like an injury or autoimmune condition?
This can still help, especially when pain has outlived the original cause, or when there's more pain than the tissue damage would explain on its own. We'd talk it through in a consult before assuming anything.

How long until I notice something?
Most PRT research shows meaningful shifts in 4–8 weeks. In my practice, small changes often show up in the first 2–4 sessions, bigger ones over 8–16. Complex cases take longer. Chronic illness on top of chronic pain takes longer.

How is this different from the Curable app or The Way Out?
Curable and Alan Gordon's book are based on the same framework and they're genuinely good self-guided resources. Working with a clinician gets you individualized assessment, live somatic tracking, and someone to help when things get complicated — which, in my experience, they almost always do.

I have ME/CFS or Long COVID. Is this safe for me?
Sometimes yes, sometimes no. PRT-informed work can help with co-occurring pain in these populations, but it is not a treatment for ME/CFS or Long COVID themselves, and it should never involve pushing through post-exertional malaise. With these clients I prioritize pacing first, every time.

Start With A Free 20-Minute Call

Not sure if this is the right fit? That's what the consult is for. No pressure, no commitment — just a chance to talk about your pain, what you've tried, and whether my approach makes sense as part of your plan.