How does "Approach the pain sensation with curiosity, not bracing" work?

Fear of pain amplifies pain. When the brain interprets a sensation as dangerous, it cranks up the signal — this is the fear-pain-fear loop that maintains chronic neuroplastic pain. Curiosity is the attitudinal antidote: approaching the sensation with open, interested attention sends the brain a different interpretive signal — "this sensation is being observed as data, not as threat." Repeated experiences of observing the sensation without danger occurring begin to update the brain’s prediction that the signal is dangerous.

How does "Distinguish safe sensations from genuinely dangerous signals" work?

Not every sensation calls for observation — some are tissue-damage signals that require medical response. The ability to distinguish ordinary (if alarming) neuroplastic sensation from signals of acute structural damage is what makes somatic tracking safe practice rather than reckless. The brain’s alarm volume is a notoriously unreliable indicator of tissue danger in neuroplastic pain — high alarm does not equal high danger, but zero alarm does not equal safe to ignore either.

How does "Practice somatic tracking in short, frequent sessions" work?

Neuroplastic change follows repetition, not duration. Each short session of genuinely curious observation is one update signal to the brain: "This sensation was observed. No danger occurred." Many such updates accumulate into a new prediction. Long sessions can tip into strained observation or hidden avoidance — in either case, the update signal to the brain is distorted. Brevity preserves the quality of the attention that makes each session count.

How does "Follow tracking with explicit safety reassurance" work?

Somatic tracking works by providing the brain with new evidence about the sensation. Completing the loop with an explicit safety statement — "I observed that sensation. Nothing dangerous happened. My back is safe" — consolidates the update. This parallels the post-exposure processing in exposure therapy, where articulating the outcome of non-feared exposure is part of extinction learning. Without the safety message, the brain has observed the sensation but may not have drawn the conclusion.

How does "Apply somatic tracking to difficult emotions as well as pain" work?

The brain-body system does not cleanly separate pain from emotion at the processing level — both are interoceptive signals interpreted by overlapping neural systems. Anxiety, dread, grief, and shame all have physical signatures; applying somatic tracking to those signatures uses the same mechanism as with pain: reducing the brain’s interpretation of the sensation as threat, which reduces its amplifying effect on the experience. Alan Gordon’s approach includes emotional tracking as a natural extension of pain tracking.

Alan Gordon — Pain Reprocessing

What is somatic tracking and how does it help with chronic pain?

Using curious, non-fearful attention to signals in the body to rewire the fear-pain loop

Short answer

Somatic tracking, developed by Alan Gordon as the central technique of Pain Reprocessing Therapy (PRT), involves observing bodily sensations — especially pain — with open, curious, non-fearful attention. The goal is to change the brain’s interpretation of safe signals from dangerous to neutral, which can reduce or eliminate neuroplastic pain. A 2021 randomized controlled trial (the BOULDER study) found PRT produced significant pain reduction vs placebo and usual care for chronic back pain, with 66% of PRT participants reporting being pain-free or nearly pain-free.

Chronic pain often persists not because of ongoing tissue damage but because the brain has learned to generate a pain signal as a protective alarm — even when the original injury has healed. Alan Gordon’s Pain Reprocessing Therapy targets this "neuroplastic pain" directly: by repeatedly approaching pain sensations with curious, open, non-fearful attention, you send the brain new evidence that the signal does not require protection, which can reduce or eliminate the signal over time. Somatic tracking is the core practice. It is one of the few chronic pain interventions with direct RCT support for a psychological mechanism.

The practices (6)

Why it works

Somatic tracking works specifically for neuroplastic pain — pain generated by a sensitized nervous system that has learned to alarm rather than by active tissue damage or a structural condition requiring medical treatment. Applying tracking to structural pain (herniated disc with active nerve compression, inflammatory arthritis) is not appropriate and could delay necessary care. Identifying the likely source of pain is a precondition for safe practice.

How to do it

1Check: has the pain been medically evaluated and cleared of structural cause? If not, start there.
2Look for neuroplastic indicators: pain that moves or changes, spreads symmetrically, flares with stress or emotion, persists despite normal imaging.
3Note whether the pain began during or after a period of psychological stress, not only physical injury.
4If uncertain, discuss with a clinician familiar with pain neuroscience before proceeding.

Evidence

RCT / meta-analysis

The neuroplastic pain model is consistent with neuroimaging research showing altered central nervous system processing in chronic pain; the BOULDER RCT specifically selected participants with chronic back pain and normal or minimal structural findings.

Honest caveat: The BOULDER trial targeted a specific chronic back pain population; generalization to other pain types should be made cautiously and with medical input.

— Ashar et al. (2022), BOULDER trial — PRT vs placebo and usual care for chronic back pain, JAMA Psychiatry

Common mistake: Applying somatic tracking to pain that has an active structural cause without medical evaluation, which can delay appropriate care. Neuroplastic indicators are useful but not diagnostic — medical clearance matters.

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