How to Navigate a Pain Flare After Success with PRT

by Lisa Van Allen, PhD

You finally found it: RELIEF! After months or years of chronic pain, you discovered Pain Reprocessing Therapy (PRT). You learned that your pain was neuroplastic—generated by a misfiring danger signal in the brain—rather than structural damage. You did the Somatic Tracking. You reduced the fear. You rediscovered pleasant sensations. The pain receded, and you started living your life again.

And then, out of nowhere, the pain came back.

Maybe it happened during a stressful week at work, or you banged into something, or perhaps it appeared for no reason at all. Now, the panic is setting in. Did I unlearn everything? Was the relief just a placebo? Am I back to square one?

Take a deep breath. You are not back to square one, and you haven't "failed" PRT. What you are experiencing is normal, explainable, and—most importantly—temporary.

Here is how to handle a relapse using the tools of Pain Reprocessing Therapy.

1. Understand the "Extinction Burst"

In behavioral science, when a conditioned response (like pain) starts to fade, the brain sometimes initiates a sudden spike in that response before it disappears completely. This is called an Extinction Burst.

Think of your brain like an overprotective guard dog. For a long time, it barked (created pain) at the mailman (normal movement) because it thought the mailman was a threat. Through PRT, you taught the dog to relax. But occasionally, the dog wakes up, looks around, and thinks, "Wait, are we SURE we’re safe?" and barks louder than ever to double-check.

This flare-up isn't a sign of tissue damage; it is the brain testing the waters. Remember, it’s #1 job is to keep you safe. This flare is a desperate attempt by your nervous system to grab your attention.

2. Stop the Fear-Pain Cycle

The natural reaction to a relapse is terror. We think, "Oh no, it’s back forever."

In PRT, we know that fear is the fuel for pain. When you react to the flare-up with panic, frustration, or despair, you validate the brain’s theory that something is wrong. You accidentally tell the guard dog, "Yes! Keep barking! There is danger here!"

Practical Tip: The "Safe" Mantra

When you feel the sensation spike, talk to your brain directly. Remind yourself:

"This pain is real, but the danger is not. My body is strong. This is just a neural pathway firing by mistake. I am safe."

3. Return to Somatic Tracking (With Outcome Independence)

When pain returns, our instinct is to "fix" it immediately. We try to think our way out of it or meditate it away. But in PRT, trying to fix the pain is a form of fighting, and fighting signals danger.

You need to practice Outcome Independence. This means observing the sensation without being attached to whether it stays or goes.

• Sit comfortably. Close your eyes.

• Locate the sensation. Is it hot? Sharp? Dull? Moving?

• Watch it with curiosity. Pretend you are a scientist observing a fascinating phenomenon.

• Abandon the agenda. Don't watch it so that it goes away. Watch it just to watch it.

If you can observe the pain without fear, you cut the fuel line. The brain eventually realizes the alarm signal is unnecessary.

4. Emotional Support: "Feel It to Heal It"

Neuroplastic pain often spikes during periods of high emotional pressure. PRT teaches us that repressed emotions—like rage, grief, or intense pressure to be perfect—can manifest as physical symptoms.

Ask yourself: What was happening in my life right before this flare?

• Did I have a conflict with a partner?

• Am I putting immense pressure on myself at work?

• Am I feeling guilty about something?

Sometimes, simply acknowledging, "I am incredibly angry right now," allows the brain to process the emotion emotionally rather than physically.

5. Self-Care: Soothe the System

A relapse is exhausting. Your nervous system is in a state of high alert (sympathetic arousal). Your job is to flood your system with safety (parasympathetic response).

• Dial down the "Shoulds": If your inner critic is yelling at you to be productive despite the pain, you are adding danger signals. Give yourself permission to rest—not because you are injured, but because you are being kind to yourself.

• Engage in "Joy Movement": If you can, keep moving. Bed rest often convinces the brain we are sick. Do gentle movements that you enjoy, reminding your brain that movement is safe.

• Lean in to pleasant sensations like the softness of a plush blanket, the flavor and warmth of a cup of tea, the joy of color in a beautiful picture. Watch a funny movie, talk with a friend who makes you laugh, draw or paint or sculpt with no pressure to produce anything beautiful or useful.

• Lean on others: Isolation breeds fear. Tell a trusted friend, "I'm having a rough flare-up, and I just need a distraction."

The Verdict

Recovery isn't a straight line; it’s a jagged upward trajectory. A relapse doesn't erase your progress. You have already proven that your brain can unlearn this pain. You have done it once, which means you can do it again.

This isn't the start of a new chronic cycle. It is just a bump in the road. Treat yourself with compassion, drop the fear, and watch the sensation fade. You’ve got this.