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Chronic Pain Clinic

We provide assessment and treatment for neuroplastic pain, psychophysiological disorders, and functional neurological symptoms. Using neuroscience- and trauma-informed therapies, including Pain Reprocessing Therapy (PRT), we help retrain neural pathways, reduce nervous system hypersensitivity, and support lasting recovery from chronic pain.

Neuroplastic & Psychophysiological Pain Clinic – Chronic Pain Treatment & Pain Reprocessing Therapy

Our clinic provides specialized assessment and treatment for chronic pain and persistent physical symptoms that have no clear ongoing structural explanation and have not improved with standard medical care. These conditions are real and often clinically complex, yet may remain insufficiently addressed within standard medical pathways. Using evidence-based mind–body therapy, including Pain Reprocessing Therapy (PRT), we help individuals understand neuroplastic pain, retrain sensitized neural pathways, and move beyond symptom management toward lasting recovery. Care is delivered within a neuroscience-informed clinical framework that considers the interaction between brain function, stress physiology, and persistent symptom patterns. We offer in-person services in Toronto and secure virtual therapy across Ontario, Quebec, Nova Scotia, and New Brunswick.

Advances in pain neuroscience and mind–body medicine show that many chronic conditions— including tension and migraine headaches, repetitive strain injuries, chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME), fibromyalgia, persistent postural perceptual dizziness (PPPD), tinnitus, irritable bowel syndrome (IBS), and chronic neck or back pain—are often psychophysiological or neuroplastic in origin.9

Understanding Neuroplastic Pain and Mind-Body Symptoms

Pain is a protective danger signal—the brain’s way of alerting us to potential harm. When the body is injured, nerves send signals to the brain, producing pain that prompts us to withdraw from further tissue damage and allow for rest and recovery.¹ In neuroplastic pain and mind-body disorders, this “harm alarm” can become oversensitive or misfire. Even in the absence of physical injury—or after the body has healed—the brain may misinterpret normal sensations, movements, or emotions as danger signals. For individuals with a history of chronic stress, trauma, childhood adversity, systemic inequity, or mental health challenges, pain pathways can become increasingly sensitized, raising the likelihood of developing neuroplastic pain and other brain-generated mind–body symptoms.1-4

Neuroimaging research further clarifies why this occurs. Brain imaging studies show substantial overlap between the neural circuits involved in physical pain (such as injury) and emotional pain (such as social rejection).5,6 These findings provide neuroscience support for pain research linking early adversity, trauma, depression, and anxiety—factors known to prime the brain’s threat and pain networks—with increased vulnerability to developing neuroplastic pain and psychophysiological disorders. With cumulative stress or adversity, these shared neural pathways can become increasingly hypersensitized, such that even minor stressors may reactivate them—a hallmark feature of neuroplastic and psychophysiological conditions.7,8

Toronto Brain Health | Neuropsychological Evaluation

How Common Are Psychophysiological Disorders?

Mind–body and medically unexplained symptoms are common, affecting approximately one-quarter to nearly one-half of patients seen in primary care settings, depending on how symptoms are defined and measured.10-13 The encouraging news is that these brain-based symptoms are often reversible. With the right treatment, pain and other symptoms can be unlearned and resolved through evidence-based mind–body therapies such as Pain Reprocessing Therapy (PRT), in combination with Cognitive Behavioural Therapy (CBT), Emotion-Focused Therapy (EFT), and mindfulness-based approaches.

Treatment Approaches for Neuroplastic and Psychophysiological Pain

Our neuropsychologists provide formulation-guided treatment for neuroplastic and psychophysiological pain, integrating Pain Reprocessing Therapy and other neuroscience- and trauma-informed approaches. Care is individualized based on each person’s symptom mechanisms, contributing factors, and clinical presentation.

The first step in care is ensuring that medical or structural conditions requiring standard medical treatment have been appropriately evaluated. This process is typically completed by a family physician or medical specialists before—or, in some cases, alongside—beginning services at Toronto Brain Health.

Once structural causes have been excluded, our neuropsychologists conduct a confirmatory neuroplastic pain or psychophysiological disorder assessment. When there is a psychophysiological disorder diagnosis or neuroplastic pain is identified, we provide neuroscience-informed, trauma-sensitive psychological and behavioural therapies aimed at addressing the brain–body mechanisms that maintain chronic pain and persistent physical symptoms.

Treatment is guided by individualized clinical formulation, reflecting each person’s symptom mechanisms and contributing factors, and may include a combination of the following evidence-based approaches. These approaches are selected based on the specific mechanisms contributing to symptom persistence and recovery.

 

  • Pain Reprocessing Therapy (PRT) for brain retraining and unlearning chronic pain
  • Cognitive-Behavioural Therapy (CBT) for chronic pain 
  • Mindfulness-Based Interventions for nervous system regulation
  • Emotion Focused Therapy (EFT) for unresolved emotions driving chronic pain
  • Cognitive Processing Therapy (CPT) for trauma-related pain
  • Other evidence-based psychotherapies for co-occurring conditions such as PTSD, depression, anxiety, and chronic stress that sustain autonomic nervous system hyperarousal and maintain pain.

 Key Treatment Targets in Neuroplastic and Psychophysiological Pain

Treatment focuses on addressing the key factors that perpetuate pain and physical symptoms, including:

  • Psychoeducation to build understanding of how brain and nervous system processes contribute to the persistence of chronic pain
  • Emotional responses that can amplify pain-related threat signaling
  • Autonomic nervous system dysregulation and persistent physiological threat activation
  • Trauma-related processes and challenges in emotional awareness or processing that contribute to nervous system sensitization
  • Depression, anxiety, and related conditions that contribute to sustained internal stress and physiological sensitization
  • Long-standing personality, interpersonal, and coping patterns that contribute to persistent nervous system sensitization

Through this integrated approach, clients learn to retrain pain-related neural pathways, reduce nervous system sensitization, and establish emotional and interpersonal safety, allowing persistent pain and symptoms to lessen or resolve over time

Persistent Pain and Neuroplastic Conditions We Treat

We work with individuals experiencing a range of persistent pain and physical symptom conditions that are commonly influenced by neuroplastic or psychophysiological processes, including the following:

  • Tension and migraine headaches
  • Persistent Postural-Perceptual Dizziness (PPPD)
  • Irritable Bowel Syndrome (IBS)
  • Chronic abdominal, pelvic, or vomiting syndromes
  • Chronic Fatigue Syndrome / Myalgic Encephalomyelitis (CFS/ME)
  • Fibromyalgia
  • Central sensitization and related chronic pain presentations
  • Numbness, tingling, or burning sensations (paresthesias)
  • Post-concussion syndrome or concussion with persistent symptoms
  • Post-viral or post-concussive light, screen and sound sensitivities
  • Tinnitus
  • Myofascial pain syndrome
  • Persistent symptoms following COVID-19 infection (Long Covid) where structural causes have been ruled out
  • Post-viral syndromes
  • Back pain, neck pain, or foot pain with no identifiable injury or persistent pain beyond the expected healing period
  • Somatic Symptom Disorder (SSD)
  • Functional Neurological Disorder (FND)
  • Other persistent physical symptoms where neuroplastic or psychophysiological mechanisms may be contributing

For individuals whose symptoms arise in the context of neurological or medical conditions, psychological and cognitive interventions may be integrated within a broader neuropsychological rehabilitation pathway. Interventions are formulation-guided and may include targeted cognitive rehabilitation and neuroscience-informed psychological therapies to support recovery, cognitive capacity, and participation in complex occupational and life roles.

Clients experiencing overlapping symptoms related to concussion or post-concussion syndrome may benefit from coordinated assessment and treatment through our Concussion Clinic or, for elite and professional athletes, our Sport Concussion Clinic.

For concerns primarily related to cognitive functioning or the differential diagnosis of neurodegenerative conditions, neuropsychological assessment services are available through our Neuropsychological Evaluation or our Acquired Brain Injury Clinic.

FAQs about neuroplastic pain and psychophysiological conditions

Find answers to common questions about our chronic pain treatments, what they involve, and how they can help. If you have any other questions, please contact us.

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What is Pain Reprocessing Therapy (PRT)?

Pain Reprocessing Therapy (PRT) helps individuals recover from chronic pain by retraining the brain to interpret previously threatening sensations or triggers as safe. Chronic pain—especially when not caused by ongoing tissue damage—can develop when neural circuits become sensitized or conditioned to misread harmless signals as threats. PRT helps modify these learned pain pathways through repeated experiences of safety and reduced threat signalling.14,15

When the brain no longer interprets sensations or movements as dangerous, the overactive pain response can subside—often leading to a significant reduction or full resolution of symptoms. A randomized controlled trial and emerging research suggest that Pain Reprocessing Therapy (PRT) can lead to significant reductions in chronic pain and related symptoms.16

We provide Pain Reprocessing Therapy in-person in Toronto and online across Ontario, Quebec, and Atlantic Canada.

What is the difference between psychophysiological disorders and neuroplastic pain?

Psychophysiological disorders and neuroplastic pain both describe real physical symptoms that arise from changes in how the brain and body communicate, rather than from ongoing tissue damage. The primary difference lies in emphasis and terminology. Psychophysiological disorder is rooted in traditional diagnostic and clinical language, while neuroplastic pain reflects modern neuroscience research describing how pain is learned, maintained, and can be unlearned through changes in neural pathways.

Psychophysiological disorder refers to physical symptoms that are influenced or maintained by stress, emotion, or maladaptive coping patterns. Historically, this condition has been described using many related terms, including tension myositis syndrome (TMS), tension myoneural syndrome, somatic symptom disorder, somatoform disorder, conversion disorder, functional neurological disorder (FND), psychosomatic illness, mind–body syndrome, medically unexplained symptoms, and central sensitivity (or sensitization) syndrome. Informed by the widely accepted biopsychosocial model of pain,² this diagnostic framework recognizes that the mind, brain, and body function as an integrated system. When stress, trauma, or prolonged emotional strain repeatedly activate the body’s stress response, it can alter neural, muscular, endocrine, and autonomic nervous system pathways—resulting in real pain, fatigue, and other physical symptoms, even in the absence of structural injury or disease.17-19

Neuroplastic pain, by contrast, is a neuroscience-based model that explains how chronic pain can develop and persist through learned neural pathways. In this model, pain circuits become sensitized, leading the brain to misinterpret normal or “safe” sensations, movements, or emotions as threatening. Over time, these pathways can reinforce themselves. Importantly, neuroscience research shows that these patterns are reversible and can be unlearned through evidence-based mind–body therapies such as Pain Reprocessing Therapy (PRT), Cognitive Behavioural Therapy (CBT), and emotion-focused interventions.16,20

In short, psychophysiological disorder refers to the diagnostic framework, while neuroplastic pain describes the underlying brain-based mechanism. Both terms reflect the same reversible process—real, brain-generated symptoms that can be effectively treated through neuroscience-informed, mind–body therapy.

Are my symptoms “all in my head”?

No—your symptoms are not imagined or “just psychological.” They are real physical experiences. In some cases, however, symptoms may be caused by neuroplastic pain or a psychophysiological (mind–body) disorder rather than by ongoing tissue damage or disease.

In these conditions, the brain’s pain- and threat-processing networks can become sensitized, sending “false alarm” pain or symptom signals even when no injury is present. Symptoms may be triggered or amplified by chronic stress, unprocessed or unresolved emotions, or past trauma, which can make the pain feel both intense and distressing.

Pain Reprocessing Therapy (PRT) and other evidence-based mind–body treatments help safely retrain these learned neural pathways. Through education, emotional awareness, and nervous system regulation, clients learn to reduce fear-based responses and help the brain recognize that normal sensations and emotions are safe. Over time, this process can calm the nervous system, reduce hypersensitivity, and allow symptoms to gradually resolve.

Can this help if I’ve already tried other therapies or medications?

Yes. Many clients come to Toronto Brain Health after trying multiple medical, physical, or pharmacological treatments without lasting relief. Mind–body therapy takes a different approach—rather than focusing solely on symptom management, it targets the sensitized pain circuits and dysregulated brain–body communication that can perpetuate chronic pain and other physical symptoms.

Chronic pain often evolves into a pain–fear cycle, in which the brain begins to misinterpret normal sensations or movements as dangerous. This can trigger fear, hypervigilance, and avoidance, which in turn reinforce pain and maintain nervous system sensitivity and distress. Mind–body therapies, including Pain Reprocessing Therapy (PRT), aim to interrupt this cycle by helping the brain and nervous system relearn safety and reduce fear-based responses to pain and bodily sensations.

Clinical research—including randomized controlled trials of Pain Reprocessing Therapy (PRT), Cognitive Behaviour Therapy and Emotional Awareness and Expression Therapy (EAET)—has shown that these evidence-based treatments can lead to meaningful and lasting improvement, even for individuals who have experienced neuroplastic pain or psychophysiological disorders for many years.16,20 This aligns with our extensive clinical experience working with individuals presenting with chronic pain and persistent physical symptoms.

If you are experiencing persistent pain or physical symptoms that have not improved with standard care, we offer specialized mind–body therapy in Toronto and secure virtual treatment across Ontario, Quebec, Nova Scotia, and New Brunswick.

Do you work with people who have had trauma or adverse life experiences?

Yes absolutely. Research shows that many people living with chronic pain have a history of trauma, childhood adversity, or prolonged life stress.4, 21-24 These experiences can make the nervous system more sensitive over time, increasing its vulnerability to stress and raising the likelihood of developing persistent pain or physical symptoms later in life.4,7

We take a trauma-informed approach to chronic pain treatment, recognizing that trauma may be one of several contributing factors, not the sole cause. Therapy is offered in a safe, supportive, and collaborative environment, where emotional connections to symptoms can be explored at a pace that feels manageable. When appropriate, we integrate evidence-based therapies such as Emotion-Focused Therapy (EFT) and Cognitive Processing Therapy (CPT) to help process unresolved emotions, develop perspective, reduce nervous system hyperarousal, and support recovery.

Our Approach to Chronic Pain Treatment

Our approach is informed by the latest neuroscience and mind–body research, integrating principles from pain reprocessing, emotional processing, and trauma recovery. We begin with a comprehensive evaluation to determine whether a client’s symptoms are consistent with a psychophysiological or neuroplastic pain condition.

Recognizing when persistent symptoms are being maintained by neuroplastic or mind-body processes can open the door to meaningful recovery. When pain and physical symptoms are understood as brain-based rather than the result of ongoing tissue injury, clients can being engaging in treatment from a place of greater safety, confidence, and optimism. Research suggests that understanding symptoms as arising from reversible neural processes allows therapy to focus on retraining sensitized pain pathways, reducing fear-based responses, and addressing the emotional and physiological factors that sustain a heightened threat state.9

This understanding provides the foundation for the neuroscience- and trauma-informed care offered at Toronto Brain Health. Treatment is guided by individualized clinical formulation and may include a tailored combination of Pain Reprocessing Therapy (PRT), Cognitive Behavioural Therapy (CBT), Cognitive Processing Therapy (CPT), mindfulness-based approaches, and Emotion-Focused Therapy (EFT).

We work within a multidisciplinary, biopsychosocial framework, collaborating with referring physicians, allied health providers, and medical specialists to ensure coordinated care that remains aligned with each client’s clinical formulation.

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References
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