In pain-reprocessing therapy, therapists start with reeducating patients about the source of pain, usually with personalized evidence from their medical history
Photo-Illustration: The Cut For as long as I can remember, I’ve been in pain. It started with my jaw, which ached even in elementary school. My dentist thought braces might fix the problem, but all I got was a $10,000 smile and green bruises below my cheekbones. In adolescence, my right knee had a nasty habit of dislocating — at home, at school, and once in the middle of downward dog. As I got older, the pain pushed up like a storm front, where it still thunders between my shoulder blades.
Still, the possibility is tantalizing. Pain patients have a long and complicated history with psychotherapy stretching back more than a century. Today, many end up in cognitive behavioral therapy, or CBT, which often feels like nothing more than a Band-Aid on the bigger issue. Pain-reprocessing therapy, by contrast, is one of the only psychological treatments known to cure pain — at least in some patients with nociplastic pain, or pain that occurs in the absence of obvious physical damage.
Acute pain is a universal human experience, but chronic pain — obliquely defined as pain that lasts longer than should be expected from the initial injury — defies the supposed boundaries between sickness and health, the mind and the body, often with startling results. Where Aristotle thought pain was an emotion and René Descartes saw it as a sensation , chronic pain today looks a lot like an identity, a defining way of moving through the world.
Chronic-pain patients have a growing body of evidence to support their lived experience. In 2017, the International Association for the Study of Pain carved out a third category of pain: nociplastic. In addition to pain caused by tissue damage and nerve damage, doctors now recognize that some pain comes from changes to the central nervous system. It often begins with physical damage, but even as the injury heals, the pain can linger, becoming chronic, widespread, and unusually intense.
For Deborah Barrett, the pain started one day in June 1994, as she was weeks away from finishing her Ph.D. in sociology at Stanford University. A burning sensation started in her arms and swept across her body. Instead of continuing with a planned postdoctoral fellowship, she withdrew to her parents’ home in Pennsylvania. Eventually, she pursued a diagnosis — fibromyalgia — and found a new calling in psychotherapy.
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