Do mind-body treatments for chronic pain work?
Quick answer: Some do, for some people. Pain reprocessing therapy had a strong result in one randomized trial of 151 adults with chronic back pain, and cognitive behavioral therapy, acceptance and commitment therapy and emotional awareness therapy have trials behind them too. Most research is in back pain and fibromyalgia, with little direct research on hand and arm pain. These approaches work best alongside a proper medical check and physical care, not instead of them.
Health note: This page is general information, not medical advice. If you have numbness, weakness, night pain or symptoms after an injury, see a doctor first. When to see a doctor
What is a mind-body treatment for pain?
It is a treatment that works on how your nervous system and brain handle pain, using education, thinking skills, emotional work or relaxation. It does not assume the pain is imaginary. German health information explains that stress, anxiety and low mood can make pain feel stronger, and that long-lasting pain can make nerves more sensitive. If you have not read it yet, start with why pain can continue when tests are normal.
The senior author of the pain reprocessing trial put it this way:
"This isn't suggesting that your pain is not real or that it's 'all in your head,'" Wager said. "What it means is that if the causes are in the brain, the solutions may be there, too." — Tor Wager, PhD, neuroscientist and senior author of the trial, then at CU Boulder, quoted in How therapy, not pills, can nix chronic pain and change the brain, CU Boulder Today, September 2021
Which treatments have evidence?
| Treatment | What it involves | Evidence |
|---|---|---|
| Pain reprocessing therapy (PRT) | Learning to see pain as less dangerous, with somatic and exposure techniques | Some evidence. One randomized trial, in chronic back pain with no clear physical cause |
| Cognitive behavioral therapy (CBT) | Changing unhelpful thoughts and avoidance habits | Some evidence. A Cochrane review of 59 CBT trials found very small to small benefits for pain, disability and distress |
| Acceptance and commitment therapy (ACT) | Living by your values while pain is present | Some evidence, with uncertainty. A meta-analysis of 33 trials found small-to-medium gains in pain intensity and function, but the same Cochrane review rated its smaller set of ACT trials as very low to moderate quality |
| Emotional awareness and expression therapy (EAET) | Processing emotions linked to the pain | Some evidence. A fibromyalgia trial (230 adults) was no better than education on pain severity but better on other outcomes, and a 2025 overview reports seven trials since 2017 |
| Pain neuroscience education | Learning how pain works | Mixed evidence. A 2026 meta-analysis found a small benefit with high variation |
| Self-guided apps | Education and exercises on a phone | Little research. One 6-week trial of Curable against a waiting list |
"Some evidence" here means at least one randomized trial or review with a positive result. It does not mean every person improves. Effects of CBT and ACT are usually small to medium, and most trials are short.
What is pain reprocessing therapy?
PRT teaches that, in many cases of long-lasting pain, the brain keeps producing pain signals that are not a sign of ongoing damage. In the 2022 JAMA Psychiatry trial by Ashar and colleagues, 151 adults with chronic back pain (about 10 years on average, with no identifiable physical cause in most cases) were split into three groups. One group got a telehealth session with a physician and then eight psychological sessions over four weeks. The others got an open-label placebo injection, or their usual care.
Afterwards, 66% of the therapy group rated their pain 0 or 1 out of 10, compared with 20% in the placebo group and 10% with usual care. The difference was still there after one year, with the therapy group averaging about 1.5 out of 10 against about 2.8 for placebo and 3.0 for usual care. Caveats apply: it was one trial, the placebo was open-label, and the people had back pain, not hand pain.
The lead researcher also stresses that the result still needs to be repeated. The "first trial" he means is the back-pain trial above:
"Our first trial had really good results, but replication is a next step." — Yoni Ashar, PhD, clinical psychologist and assistant professor, University of Colorado Anschutz Medical Campus, interviewed in Pain reprocessing therapy as an emerging non-pharmacologic treatment for chronic pain, Outlook, Society of Behavioral Medicine, Fall 2023
What is The Way Out by Alan Gordon?
The Way Out is a book by psychotherapist Alan Gordon and Alon Ziv, published by Avery. It was published as an ebook on August 24, 2021 and in paperback on August 23, 2022. The publisher describes it as a mind-body protocol for chronic pain, based on the idea that in most cases chronic pain is generated by misfiring pain circuits in the brain. It points to the University of Colorado Boulder trial described above.
A book is not the same as the therapy given in a trial. The trial used a physician session and eight sessions of psychological treatment. Read the book as an introduction, not as a replacement for assessment.
What about apps such as Curable?
Curable describes itself as a self-paced, app-based recovery program for persistent pain. Its site lists pain education, exercises such as somatic tracking, cognitive reflection, guided relaxation and expressive writing, live workshops and a daily plan. It is available on the web, the App Store and Google Play, with a free two-week trial, and says it is designed to work alongside existing care.
A randomized trial of the Curable app in 198 adults with chronic pain (average duration 13.6 years) compared 6 weeks of app use with a waiting list. The app group improved more on pain severity and pain interference, and the changes were still present at 12 weeks in that group. The trial was short and the comparison group got no active treatment, so it cannot show how the app compares with other therapies. The company also reports a member survey and calls the trial independent. Those are its own statements, and we have not assessed them. Treat an app as an option for learning and practising skills, and still get medical care.
Does any of this work for hand and arm pain?
We found little direct research. The trials above are mostly in back pain or fibromyalgia. A review of nonspecific arm pain says care for this kind of pain may need to include psychological and psychosocial elements. That supports using these approaches as one part of care. It does not show that a specific therapy works for RSI.
If you have a diagnosed hand or wrist condition, such as carpal tunnel syndrome, these treatments do not replace its standard treatment.
How do you find a therapist?
- Start with your doctor. Ask for a referral to a pain psychologist or a pain clinic. German health information describes multimodal care with pain specialists as the usual route for chronic pain.
- Check qualifications. Look for a licensed psychologist, psychotherapist or physician.
- Ask about the method. Ask whether they offer CBT, ACT, PRT or EAET and how they were trained.
- Ask about medical care. A good therapist wants you to have been assessed and keeps working with your doctor.
- Be careful with promises. Walk away from anyone who guarantees a cure or tells you to stop treatment.
Do these approaches replace physical care?
No. They combine with it. Exercise, pacing and physical therapy address what your body can do. Mind-body methods address how your nervous system responds to pain. Our page on John Sarno and RSI explains how his older ideas differ from these tested approaches.
Where to go next
By Dictop · Reviewed