And How PTI Does It Differently

Chronic pain patients are exhausted.
Not just from the symptoms—but from a lifetime of being told their pain isn’t real, isn’t physical, or isn’t “bad enough” to matter.

This is why it hits especially hard when they stumble into another modality that promises answers… only to discover the same familiar invalidation hiding underneath new language.

And yes—I’m talking about Pain Reprocessing Therapy (PRT).

I’m saying out loud what many patients have whispered to me privately:

PRT, as it’s being marketed and taught by much of the coaching world, is becoming another form of gaslighting.

But the problem isn’t the idea of PRT.
The problem is the misuse, overreach, and oversimplification of it.

At the Pain Trauma Institute, we do use PRT—but we use it responsibly, ethically, and within a whole-body, medically-informed framework that refuses to ignore the biology of chronic illness.

Here’s the truth, without sugarcoating:

1. When PRT claims to cure everything, it’s gaslighting.

PRT was tested on one group of people:
- nonspecific chronic low back pain

That’s it.

There is no evidence supporting PRT as a cure for:

EDS
autoimmune conditions
neuropathy
mast cell disorders
dysautonomia/POTS
pelvic pain
structural spinal conditions
systemic chronic illness

Telling patients with those conditions that their pain is caused by fear, thoughts, or “brain predictions” is not mind-body care.

It’s gaslighting wrapped in neuroscience vocabulary.

2. When patients are blamed for not getting better, it’s gaslighting.

How many patients have heard versions of this?

“You didn’t believe in it enough.”
“You’re still attached to the pain.”
“Your subconscious isn’t ready to let go.”
“Your fear is causing your symptoms.”

This is just the old “it’s all in your head” narrative, dressed up in therapeutic jargon.

Patients don’t fail PRT.
PRT fails them when applied to conditions it was never designed to treat.

3. When biology is dismissed, PRT becomes harmful.

Pain is not a hallucination.
Pain is not a psychological glitch.
Pain is not a misinterpreted childhood feeling trapped in the spine.

Pain is:

immune cells
connective tissue
hormones
nerves
inflammation
mechanical forces
autonomic dysfunction
trauma
history
and yes—the brain
together.

PRT works with the nervous system layer.
It does not erase structural, inflammatory, or genetic layers.

Any version that ignores this?
Gaslighting.

**4. The brain processes all pain — but it absolutely does NOT create all pain.**

This is the myth that has done the most harm.

The most cited evidence that the PRT community uses - the “man who stepped on a nail

The most cited example:

A construction worker steps on a nail, screams in agony, goes to the ER, and later discovers the nail passed harmlessly between his toes.
“See? Pain is generated by the brain!”

Here’s why this story is not a valid anchor for understanding chronic illness or complex pain — and why continuing to use it is misleading.

It’s an extreme, rare, emergency scenario — not daily chronic pain.

The man in the story experienced:

A sudden injury
In a dangerous environment
Triggering an immediate survival response
With high fear and adrenaline

This is acute threat, not chronic illness.

Comparing this to EDS pain, autoimmune flares, pelvic pain, neuropathy, or long-term spine conditions is like comparing:

a car crash to living with a genetic condition

They are fundamentally different biological states.

The example shows fear-based misinterpretation — not “the brain inventing pain.”

Pain occurs in situations where the brain expects danger — this is true.
But in the nail story:

The man saw a nail through his boot
He believed he was injured
Medical staff believed he was injured
His brain behaved exactly as it should: it initiated a pain response to protect him

This does not prove:

that chronic pain is imaginary
that pain can be reprocessed away
that pain is a “prediction error”
that all pain is brain-generated
that pain unrelated to real injury is common

It only shows that misinterpreting a threat can create acute pain.
That’s psychology 101, not a universal pain explanation.

This example cannot be generalized to chronic pain — the physiology is different.

Acute pain and chronic pain involve different mechanisms.

Acute Pain (like the nail story)

Short-term sympathetic surge
Immediate fear response
Limbic system drives the reaction
Pain ceases when the threat is clarified

Chronic Pain

Neuroimmune changes
Mast cells, cytokines, inflammatory cascades
Nervous system plasticity
Mechanical compression or instability
Autonomic dysregulation
Hormonal influences
Tissue fragility
Trauma and adversity history

The nail story is a one-time adrenaline shock, not a model for:

EDS
autoimmune disease
chronic migraines
neuropathy
spinal injury
long-term sensitization
systemic illness

It’s a misleading analogy for anyone living in a complicated body.

High-drama anecdotes are not good science.

This story comes from a single case report often misquoted in pain-psychology trainings.

Case reports are:

interesting
illustrative
but NOT generalizable evidence

Yet PRT communities treat this one dramatic anecdote like a foundational neuroscience principle.

Real science looks at:

randomized trials
mechanistic studies
biological markers
long-term outcomes
systemic contributors

The nail story is entertainment, not evidence.

The story is used to imply that your pain might also be a false alarm — which is invalidating.

The subtext patients hear is:

“If that guy screamed in pain with no injury, maybe your pain is also just a misinterpretation.”

For medically complex patients, this is:

inaccurate
dismissive
retraumatizing
and dangerously close to medical gaslighting

Pain from EDS, MCAS, autoimmune disease, neuropathy, or structural abnormalities is not a “misinterpreted threat.”
It is physiological.

The nail story is an extreme outlier used to push a narrative that minimizes real illness.

A more accurate, trauma-informed explanation:

“Yes, the brain is involved in all pain.
But that doesn’t mean all pain is created by fear or by misinterpretation.
The nail story is a dramatic example of an acute threat misreading — not a parallel to chronic illness. Your pain comes from a real combination of biology, history, the nervous system, and the body’s lived experiences. It is not a trick or a prediction error.”

:5. So what makes PTI’s approach completely different?

At PTI, we do NOT use PRT as a cure-all.
We do NOT tell patients their pain is imaginary.
We do NOT push belief-based healing or emotional origin theories.
We do NOT blame people when they still hurt.

What we do is integrate the useful parts of PRT into a full, medically-aware, trauma-informed model:

- Nervous system regulation
- Pain neuroscience education
- Somatic grounding
- Attachment and trauma work
-Pacing and capacity-building
-Collaboration with physicians
- Respect for structural & systemic illness
- Honoring the whole body, not just the brain

PRT becomes a supportive tool—not a dogma, not a cure-all, and definitely not a weapon.

6. What we believe at PTI

Your pain is real.
Your body is not lying to you.
Your symptoms are not a mindset problem.
Your biology matters.
Your history matters.
You deserve care that does not erase either one.

PRT, when held lightly and used responsibly, can help decrease nervous system amplification.
But true relief comes from treating the whole human, not reducing their illness to a misfiring alarm.

At PTI, we don’t gaslight you.
We sit with you, believe you, educate with you, collaborate with your medical team, and help you build nervous system capacity in ways that honor your story—not override it.

This is PRT done right.
This is pain care that tells the full truth.
This is what chronic pain patients deserve.

—Tracey Chester, LMFT
Founder, Pain Trauma Institute

When Pain Reprocessing Therapy Becomes Gaslighting