Neuroplastic pain

What the research actually says, from someone who spent 25 years in pain clinics

Michael G. Hunter, L.Ac. · October 2026 · About 6 minutes

This site is mine, and UpSpiral is the company I founded. I'm telling you that up front because I mention our work at the end, and you should know who's talking.

I spent 25 years putting needles in people who hurt. For part of that time I was the first staff acupuncturist in the Department of Pain Management at the Cleveland Clinic. I watched a lot of MRIs get read. I watched a lot of people get told their back was degenerating, their disc was bulging, their nerve was pinched. And I watched a lot of those people get better in ways the MRI couldn't explain, and a lot of others stay in pain after the surgery fixed the thing on the scan.

So when the research on neuroplastic pain started coming out, I didn't need convincing. I needed the data. Here's what it says, and here's where the people selling it go too far.

What "neuroplastic pain" means

Pain is made in the brain. That's not a slogan. Nociception, the signal from a damaged tissue, is one input. The brain weighs it against everything else it knows, including memory, threat, context and expectation, and then decides how much pain to produce. The International Association for the Study of Pain rewrote its definition of pain in 2020 to make this explicit: pain is "an unpleasant sensory and emotional experience," and the accompanying notes state that pain and nociception are different phenomena, and that pain cannot be inferred solely from activity in sensory neurons.

Neuroplastic pain (the researchers call it "primary" or "nociplastic" pain) is pain the brain keeps producing after the tissue has healed, or when there was never a clear tissue cause. The circuits that learned to fire keep firing. It's real pain. It's not imagined. It's just coming from the alarm system, not the house.

The study everyone cites, and what it actually found

Ashar and colleagues, JAMA Psychiatry, 2022. A randomized controlled trial at the University of Colorado Boulder. 151 adults with chronic back pain, average duration about ten years. Three arms: Pain Reprocessing Therapy (PRT), an open-label placebo injection, and usual care.

PRT was eight sessions over four weeks. The core of it: teach the patient that their pain is produced by learned brain circuits rather than tissue damage, then have them re-engage with movement and sensation while reappraising the pain as safe.

Results at the end of treatment: 66 percent of the PRT group were pain-free or nearly pain-free (a 0 or 1 on a 0 to 10 scale). That compares to 20 percent in the placebo group and 10 percent in usual care. Gains were largely maintained at one-year follow-up. fMRI showed reduced activity in pain-related regions, including the anterior insula and anterior midcingulate, in the PRT group.

That is a strong result. It is also one trial, 151 people, a single site, with the treatment developed by people on the research team. Those are the normal limitations of a first RCT and the authors say so. Until independent replications report, "66 percent pain-free" is a finding from one well-run study, not a settled number.

Where the marketing outruns the science

You'll see the claim that "85 to 90 percent of chronic pain is neuroplastic." That figure is a clinical estimate from practitioners in the field, Alan Gordon's work in particular. It is not from a peer-reviewed epidemiological study. It may be right. It hasn't been measured. If a program quotes it to you as a fact, that tells you something about the program.

You'll also see the method applied to everything: autoimmune disease, cancer pain, acute injury. The RCT evidence is for chronic back pain. Observational and clinical evidence extends to other centralized pain conditions (fibromyalgia, tension headache, IBS, chronic pelvic pain), where the nociplastic model has decades of support. It does not extend to pain with an active structural or inflammatory cause. Part of the clinical skill is telling those apart, and that's a job for a physician before it's a job for a coach.

What 25 years in the clinic adds

Three things the papers don't say that I'd stake my license on.

First: the people who get better fastest are the ones who stop being afraid of the sensation. Fear is the fuel. Every pain clinic in the world has a patient who's had three clean scans and still guards their back like it's made of glass. The guarding is the disease.

Second: pain that moves, pain that flares with stress, pain that started after a life event rather than an injury, pain that's symmetrical, and pain that shows up with a long list of other unexplained symptoms are the classic markers. Gordon and Ashar list these; so did every good pain physician I worked with, years before the term existed.

Third: the body keeps score, and so does the story. The patient who believes "my back is ruined" has a different physiology than the one who believes "my brain learned a bad habit." That belief is not a mood. It's a setting. Changing the setting is the treatment.

What to do with this

If you have chronic pain, in this order:

Get it evaluated by a physician. Rule out the things that need a surgeon, an oncologist or a rheumatologist. This is not optional, and no reputable brain-retraining program will tell you to skip it.
Ask whether your pain fits the nociplastic pattern. Bring the markers above. Many doctors now know this literature; the IASP definition change in 2020 moved it into the mainstream.
If it fits, look at pain reprocessing approaches. The Ashar protocol is published, and its components (pain neuroscience education, somatic tracking, graded exposure, emotional processing) are taught by a growing number of clinicians.
Be suspicious of anyone who promises a cure, quotes the 85 percent figure as fact, or tells you to stop seeing your doctor.

Written by Michael G. Hunter, a licensed acupuncturist with 25 years of practice and the first staff acupuncturist at the Cleveland Clinic Department of Pain Management. Published on his own site. UpSpiral, his company, applies the neuroplastic model alongside IFS parts work and nervous system regulation; his co-founder, licensed psychotherapist Leela, ran pain reprocessing therapy groups at a San Francisco pain clinic for eight years. If that's useful to you, it's at upspiral.com. If it isn't, the research above stands on its own. Not medical advice. Chronic pain should be evaluated by a physician.

Sources

Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. doi:10.1001/jamapsychiatry.2021.2669
Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982.
Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110.
Gordon A, Ziv A. The Way Out. Avery, 2021. Source of the 85 to 90 percent clinical estimate; cited here as an estimate, not as epidemiology.