You know this patient
They come back. Sometimes every few weeks, sometimes every few months. Always with the same story. Often with the same pain. They've done what you asked and you've done what you can, and they still aren't meaningfully better.
The appointments run long and their chart keeps growing. Their frustration, and yours, does too. And by now, the next reasonable step is often a repeat of something that didn't work the first time.
Many of these patients have become part of the rhythm of your practice. There's one on your schedule today, probably. They are not imagining their pain. They are not malingering. They are not difficult. But despite your best clinical reasoning, despite everything you've offered, despite their compliance, the picture has not changed.
There may be a reason it hasn't.
When structural treatment isn't enough
Your patient may have neuroplastic pain
You've ordered the imaging. You've trialed the medications. You've referred for physical therapy. Perhaps you've operated. The pathology you identified has been addressed, and the pain is still there. Or it came back. Or it moved.
It's a familiar clinical picture, and in a growing subset of your chronic pain patients, it isn't a diagnostic mystery or a failure of your care. It's a sign that a neuroplastic component (recognized by the IASP in 2017 as nociplastic pain) is driving or amplifying the presentation.
The mechanism, briefly
Neuroplastic pain is a physiological condition, not a psychological one. It arises from altered central nervous system processing: neural pathways that became sensitized through sustained nociceptive input, injury, illness, or prolonged overwhelming stress, and now continue to generate pain signals independent of ongoing tissue pathology. The same capacity that drives motor learning, memory consolidation, and habit formation is applied to the pain system, then reinforced until it self-sustains.
Central sensitization, fear-avoidance behavior, and comorbid anxiety or depression tend to cluster with this presentation and perpetuate it further.
Functional imaging confirms these aren't invented sensations. fMRI studies (including those from the 2022 JAMA Psychiatry trial on Pain Reprocessing Therapy) show distinct neural patterns in chronic pain that measurably change with targeted intervention. The pain is real. It simply originates upstream of the structural findings your imaging can detect.
Neuroplastic pain rarely presents in isolation
Which often explains your patient's incomplete response to care
A neuroplastic diagnosis does not displace the structural pathology you've identified. Your patient can have osteoarthritis, a herniated disc, endometriosis, fibromyalgia, or post-surgical pain, and also have a neuroplastic layer developing alongside it.
In practice, this mixed pain presentation is the rule, not the exception.
This layering is what makes chronic pain so difficult to treat. In a mixed presentation, there's no reliable bedside test that cleanly distinguishes nociceptive signal from centrally mediated pain. The two can be indistinguishable in how the patient experiences and reports them. Treatments aimed at the structural contributor tend to yield only partial relief, because only part of the pain generator is being addressed.
When the neuroplastic component is treated, the clinical picture becomes cleaner. Any remaining structural pain becomes easier to identify, and more responsive to the treatment you continue to provide. The neuroplastic pain itself can often be reduced to a manageable level, or resolved entirely.
We're a part of their care team, not a replacement for it
Sonavé is built to complement the care you're already providing, not to compete with it. Our program runs for eight weeks. After that, your patient returns to you. You remain their primary provider for everything else.
During the program, we focus specifically on the neuroplastic component of their pain. We do not perform imaging. We do not provide structural treatment. We do not seek to become their long-term provider for any of it. The treatments you offer – physical therapy, interventional procedures, surgical care – remain entirely with you.
What changes when they come back for treatment
For surgical care
The clinical picture becomes legible. You can see what's actually structural, and what was being amplified by an over-firing central nervous system.
Decisions about further intervention become clearer for everyone, and the surgical outcomes improve.
For physical therapy
The patient who plateaued on rehab, who couldn't push through fear-avoidance, who avoided certain movements, whose pain spiked disproportionately with effort – this patient can finally engage with your program.
They progress where they were stuck. They tolerate loads and progressions they couldn't before. The work you do begins to land.
For pain management
Interventional procedures often work better once neuroplastic amplification has quieted.
The pain that wouldn't respond to a previously appropriate injections or medications sometimes does, once the central sensitization layer is reduced.
When a patient completes our program, the neuroplastic layer of their pain is typically reduced or resolved. That alone changes what becomes clinically possible in your hands.
Neuroplastic pain is not an acute stress disorder
Neuroplastic pain is not effectively treated with lifestyle counseling, general wellness advice, or standard stress-management referrals (though these can be healthy adjuncts). Clinicians unfamiliar with the mechanics of nociplastic pain sometimes interpret it as psychosomatic or primarily stress-related – routing patients to CBT, psychiatry, or self-care resources where it will not fully resolve.
Stress is a known modulator of neuroplastic pain. It can trigger flares, reinforce sensitized pathways, and perpetuate the presentation, but it is not the etiology.
The underlying cause is maladaptive neuroplasticity: specific neural pathways in the central nervous system that have become sensitized and self-sustaining, independent of psychological state.
This is a physiological condition. It responds to a structured, protocol-driven clinical intervention, not to lifestyle counseling, stress management, or psychiatric care alone.
How we work within your care matrix
You evaluate your patient based on our neuroplastic pain referral criteria
Send us the referral, where we follow up with the patient to assess their candidacy for treatment
Approved patients enter our 8-week program designed specifically for neuroplastic pain
The patient continues any care necessary for structural damage – now with reduced or eliminated pain
Built on research that speaks for itself
At the heart of our program is Pain Reprocessing Therapy® (PRT), a treatment approach that is reshaping how chronic pain is understood and treated.
Effect of Pain Reprocessing Therapy® vs Placebo and Usual Care
In 2022, researchers at the University of Colorado published what many consider the most striking clinical trial in chronic pain research to date. The study, published in JAMA Psychiatry, compared Pain Reprocessing Therapy to a placebo treatment and to usual care in adults with chronic back pain. Ashar et al., JAMA Psychiatry, 2022
Pain-free or nearly pain-free in 4 weeks
66%
PRT®
20%
Placebo
10%
Usual Care
98% reported a significant reduction in pain
These are among the largest effect sizes documented for any non-pharmaceutical chronic pain intervention. The study also included longitudinal fMRI imaging showing reduced activation in pain-related regions (the anterior midcingulate, anterior insula, and anterior prefrontal cortex) along with altered connectivity consistent with the proposed neural mechanism of the therapy.
The Boulder trial focused specifically on chronic low back pain. The mechanism it targets, however, maladaptive central neuroplasticity, is increasingly recognized as a driver across a broad range of chronic pain syndromes: fibromyalgia, chronic pelvic pain, TMD, migraine, persistent post-surgical pain, IBS, and other nociplastic presentations. A patient's candidacy for our program is determined by the presence of that mechanism, not by the specific diagnosis or anatomical location of their pain.
Want to learn more about our primary treatment method?
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Diagnoses commonly related to neuroplastic pain
Musculoskeletal and orthopedic
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Chronic low back pain
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Osteoarthritis
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Neck and shoulder pain
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Knee, hip, and joint pain
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Persistent pain after surgery
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Myofascial pain syndrome
Widespread / central sensitization conditions
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Fibromyalgia
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Complex Regional Pain Syndrome (CRPS)
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Chronic fatigue syndrome / ME/CFS
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Chronic widespread pain without a structural explanation
Headache and facial pain
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Chronic migraine
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Tension-type headaches
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TMJ/TMD (jaw pain and dysfunction)
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Occipital neuralgia
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Trigeminal neuralgia (sometimes has a neuroplastic layer)
Pelvic pain conditions
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Chronic pelvic pain (in all genders)
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Endometriosis-related pain (the neuroplastic layer beyond the structural disease often persists after treatment)
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Vulvodynia
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Interstitial cystitis / painful bladder
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Chronic prostatitis
Gastrointestinal
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Irritable bowel syndrome (IBS)
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Functional dyspepsia
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Chronic abdominal pain without clear structural cause
Other conditions
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Ehlers-Danlos syndrome and other hypermobility disorders
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POTS and dysautonomia
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Long COVID pain syndromes
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Post-concussion syndrome with persistent pain
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Chronic whiplash-associated disorders
Sensory-Based Pain Modulation Therapy™ – our protocol
PRT is the foundation. Our proprietary protocol goes further.
Sensory-Based Pain Modulation Therapy™ integrates three additional evidence-informed modalities into the PRT framework, each selected to reinforce the nervous system's capacity for adaptive change:
Acoustic therapy engages the nervous system through sound and vibration, supporting parasympathetic activation – the autonomic state in which neuroplastic learning and regulation can occur.
Therapeutic horticulture uses structured contact with plants and living environments, a practice with a growing evidence base for its effects on stress reduction, attentional restoration, and autonomic regulation.
Mind-body connection work comprises structured interoceptive and somatic practices that help patients re-engage with safe, embodied sensation, a targeted counterweight to the hypervigilance and threat-appraisal patterns that characterize chronic pain.
Each modality engages a distinct pathway to the same neuroplastic endpoint. The result is a multi-sensory, mechanism-matched protocol that extends beyond cognitive reappraisal alone.
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