Dr. Martina Melzer, published: 4/14/25

More than 12 million people in Germany have chronic pain. Most of them are told that they have to live with their pain. They should learn ways to cope with the pain better, deal with it differently and manage to regain a better quality of life. In addition, many people take painkillers on a permanent basis.

For some types of pain, it is possible to unlearn the pain (among other things) through psychological techniques and thus actively retrain the misdirected processes in pain processing. The pain memory should be reduced and “updated” with new information.

• Chronic neuropathic pain: This pain is caused by damage to or dysfunction of nerve fibers. The causes are typically diabetes, injuries, infections or other illnesses.

• Chronic nociceptive pain: This pain is caused by tissue damage as a result of injury, inflammation or other organ damage, for example osteoarthritis or rheumatism.

• Chronic neuroplastic / nociplastic pain: In this case, the pain is caused by neuroplastic changes in the brain and not (or no longer) by tissue damage. The pain is caused by the brain's misinterpretation of tissue stimuli. Examples include chronic back pain that cannot be explained in any other way, neck pain, headaches, fibromyalgia and irritable bowel syndrome.

Particularly in the case of back or neck pain, abnormalities are often found in MRI or other diagnostic imaging procedures. However, this is not proof that the pain is caused by degenerative changes in the spine, for example. Because even in “healthy” people who do not have chronic pain, exactly the same changes are found in the MRI.

Chronic pain caused by permanent nerve or tissue damage cannot be unlearned using psychological techniques, whereas neuroplastic pain can. However, pain can often take on a life of its own, even in the case of nerve or tissue damage.It suddenly occurs in other parts of the body, wanders, comes and goes. Here it is often obvious that neuroplastic processes also play a role, which can be positively influenced.

Neuroplastic pain is usually the result of chronic stress, trauma and/or adverse childhood experiences. Fear conditioning also plays a central role. Psychological processes, psychosocial stress and emotional processes then manifest themselves in chronic physical pain. The interplay between mind, brain and body is out of balance, i.e. between “mind” and “body”, hence the term “mind-body syndrome”.

Psychological techniques and therapies can include education about chronic pain, psychotherapies such as cognitive behavioral therapy or other psychological methods that help to better understand and cope with pain. I would like to focus here on two specific approaches that I learned from the US mind-body and pain specialist Professor Howard Schubiner, among others, called Pain Reprocessing Therapy and Emotional Expression and Awareness Therapy.

Pain Reprocessing Therapy:

This psychological technique aims to actively reduce the changes in the brain and nervous system, the malfunctioning pain processing processes, to unlearn them, to retrain the brain through neuroplasticity. This is not about increasing acceptance of pain or coping better with it, but about unlearning the chronified pain processes. Initial studies are promising: by breaking the vicious circle of stress - pain - anxiety - more stress - more pain - more anxiety, chronic pain can be significantly reduced or even disappear completely and permanently.

Emotional Expression and Awareness Therapy:

This psychological technique targets the emotional processes that are often behind chronic neuroplastic pain. Those who do not want to feel their emotional pain or suppress certain emotions communicate their body through physical pain. It is important to find access to difficult emotions, to become aware of one's stress patterns, to recognize, process and change stressful things from the past and present. Here too, initial studies have shown a lasting positive effect.

Translated with DeepL

Important: The statements in this text are the result of my research from scientific studies, professional articles, books, courses, education and training as well as my own recovery process. I have done the best possible research, but nevertheless make no claim to accuracy. In science, something is considered a hypothesis until it is clearly proven (or disproven). That is then evidence, a fact. The statements in this text are a combination of hypotheses and facts.

Also, the content on this page is for informational purposes only and is not a substitute for talking to your doctor or other therapist. Please talk to your doctor or therapist before making any decisions about your physical or mental health. Every way into a mind-body syndrome is something individual, and every way out.