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'Fear is the fuel for pain,' says expert

Shelby Ramsey

Special to the Village News

Fear is an incredibly powerful emotion that when lessened and/or eliminated from the picture can bring about profound positive change in human lives. What many people may not realize is that a correlation between fear and pain has been researched with interesting results.

The research findings have led to Pain Reprocessing Therapy (PRT), which is "an evidence-based treatment for chronic pain."* It centers on "retraining the brain" to reduce and in some cases, eliminate cyclic pain.

Paulina Assaf, ASW, director of operations at Pain Reprocessing Therapy Center in Los Angeles, said the center's goal "is to expand awareness around this novel treatment model and affect the beginning of a paradigm shift in the way chronic pain is treated and understood."

To familiarize you with the basics of PRT, Assaf explained it "aims to eliminate the fear around the pain, in order to deactivate the brain's danger signals and help patients interpret sensations more accurately."

She knows that many individuals may hesitate to initially believe the correlation, but through experiencing PRT, "they begin to gain corrective experiences, or instances where pain is relieved when it normally would not be."

This, in turn, "[brings] less fear, acting as a positive feedback loop," she said.

Many conditions lead patients to seek out PRT. The top three conditions the clinic treats patients for include, "back pain, pelvic pain, and fibromyalgia," Assaf said.

A statement from Assaf that is bound to reassure patients is, "All pain is real." She clarified that by explaining that "all pain is generated by the brain."

An example she provided is easily applicable. "Normally when we injure ourselves, the body sends signals to the brain informing us of tissue damage, and we feel pain. But sometimes, the brain misinterprets safe messages from the body as if they were dangerous."

It's safe to say everyone understands fear. Britannica Dictionary defines it as: "An unpleasant emotion caused by being aware of danger; a feeling of being afraid."

Patients are routinely asked to define their various levels of pain (i.e. the Stanford Pain Scale, 1 to 10) in an individual sense.

Pain: "The physical feeling caused by disease, injury or something that hurts the body"; "Mental or emotional suffering: sadness caused by some emotional or mental problem," Britannica Dictionary.

Assaf said, "Because pain is a danger signal, the perception of potential tissue damage can cause the brain to generate pain even in the absence of damage."

The good news is, "just as pain can be learned, it can also be unlearned," she said. "Interestingly, brain scans of chronic pain patients show brain activity related to the subjective perception of pain in regions related to emotions, beliefs, learning... and meaning making!"

Once seeking out PRT, what can one expect?

"There are two prongs to our treatment model," said Assaf. "We approach both the patient's fear around their symptom, and their relationship to fear in general."

"To treat the fear around a sensation, I first guide patients to bring awareness to the pain, then cognitively reappraise the sensation as physically safe, and finally work to reinforce this lens of safety to the primitive brain with techniques such as somatic tracking or leaning into positive sensations," she said.

The benefit of following this model allows therapists to "aim to minimize sensations that have been amplified by the brain's fear response," she explained.

Some believe that fear almost serves as a gate, but once they get through the gate, opportunities abound.

Its common in PRT to need to identify, focus and shift attention to emotional threats.

Assaf unraveled this, "The perception of emotional threats in one's environment actually intimately connects with the perpetuation of pain symptoms, as there is an overlap between the different physical systems that assess for threats."

In her patients she "finds that the most common emotional threat ... is a fear of uncertainty."

This is not isolated to PRT. "For chronic pain patients, there is often so much uncertainty around their diagnosis alone," she said.

If you are living in chronic pain and open to exploring new treatment options, perhaps PRT is worth looking into.

*To learn more about PRT you can visit:

Shelby Ramsey is the author of the blog,, which also features interviews with patients and medical experts.


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