Dr. Eshay Friedman
Emergency Medicine Specialist & Chronic Pain Therapist using PRT (Pain Reprocessing Therapy)
- info@chronicpain.co.il
- Sdeh Yaakov
- קרא בעברית
Dr. Eshay Friedman
Treats chronic pain using the PRT methodology.
Graduated with dean's honors from medical school and specialized in emergency medicine.
After years working in emergency departments across Israel, he encountered many patients with conditions he couldn't adequately treat through conventional medicine. He saw them returning again and again with chronic pain, vertigo, and migraines — leading to frustration and loss of trust in the healthcare system.
He always knew their pain was real, but didn't know how to truly help beyond prescribing another painkiller — a bandage over a deeper wound.
He discovered the work of Dr. John Sarno and later Dr. Howard Schubiner and his colleagues, and was glad to find fellow professionals who share his thinking about the mind-body connection and how to genuinely treat pain at its root.
He learned from Dr. Schubiner and Alan Gordon the mind-body treatment approach and now helps people eliminate chronic pain and live fuller, more satisfying, pain-free lives.
About the Method
Recent research demonstrates that chronic back pain, neck pain, fibromyalgia, and headaches typically stem from psychophysiological processes (neuroplastic pain) rather than physical causes — and can be changed.
Pain serves as a danger signal. When we injure ourselves, the body sends a signal to the brain reporting tissue damage, and we feel pain. But sometimes the brain can make a mistake! Neuroplastic pain arises when the brain misinterprets safe body signals as dangerous. In other words, neuroplastic pain is a false alarm.
Although this pain can be treated psychologically, that doesn't mean it is imaginary. In fact, brain imaging studies have confirmed that the pain is completely real. Recent research shows that pain is often the result of learned neural pathways in the brain — and just as a pain pathway can be learned, the brain can learn a different one.
PAIN REPROCESSING THERAPY, or PRT, uses psychological techniques to train the brain to reinterpret signals that are translated into pain, breaking the cycle of chronic pain.
The method was proven effective in a study published in September 2021, in which 100 people with chronic back pain were treated. Half received PRT sessions twice a week for four weeks; the other half continued standard care. In the PRT group, approximately 98% reported improvement, and 66% had no or minimal pain at the end of treatment. These results were maintained after approximately one year.
Is the Problem Physical?
Conventional medicine assumes lower back pain indicates a back problem, leading to imaging (CT, MRI), injections, and heavy pain medication use.
The standard belief is that the painful location is the problem source. However, MRI/CT changes don't necessarily cause pain — especially chronic pain. The actual source involves brain changes that create pain sensation unnecessarily.
Multiple studies on asymptomatic, pain-free individuals revealed numerous imaging abnormalities despite the absence of any symptoms.
European Spine Journal (PMID: 22990606), 2013, 708–13. M Matsumoto et al
Lumbar and cervical intervertebral changes in asymptomatic individuals.
MRI showed degenerative changes [including bulges, compressions, and stenosis] in both the lumbar and cervical spine in 78.7% of asymptomatic volunteers [average age 48].
New England Journal of Medicine: Vol 331; 69 – 73, July 14th 1994, No. 2 Maureen C Jensen et al
Magnetic resonance imaging of the lumbar spine in people without back pain showed disc bulges and degeneration in many. Conclusion: many people without back pain have disc bulges and degeneration. Given the high prevalence of these findings and of back pain, discovery of such findings on MRI of the lower back may often be incidental.
Spine (PMID: 11295915), 2001, 149–54. N Karppinen et al
Symptom severity and signs versus MRI findings in patients with sciatic pain. Conclusions: "No relationship was found between symptoms and the degree of disk bulge or nerve compression in 160 patients with unilateral sciatica.
The Journal of Bone and Joint Surgery, Vol 72, Issue 3 403-408, 1990 SD Boden et al
Abnormal magnetic resonance scans of the lumbar spine in asymptomatic individuals: a prospective investigation. Conclusions: approximately one-third of subjects had significant abnormalities (57% in those aged 60 and above).
Journal of the Korean Neurosurgical Society (PMID: 23440899), 2013, 31–8. SJ Kim et al –
Prevalence of disc degeneration in asymptomatic Korean individuals. Lumbar spine. Conclusions: "Lumbar MRI of asymptomatic volunteers (age 14–82, mean age 46) showed that 60% had bulges, 76% had annular fissures, and 76% had nuclear degeneration."
Ann Rheum Dis.2003; 62: 371-372 Centeno and Fleishman
Lower back pain in individuals with degenerative disc disease. Conclusions: "Degenerative disc disease, as seen on imaging, is not necessarily a painful condition."
It appears, therefore, that pain does not originate from findings revealed in imaging, but from another source — a body-mind integration, where physical expression of pain is driven primarily by suppressed emotion, or simply a false alarm of the sympathetic nervous system activating unnecessarily.
Pain (however severe) from a neuroplastic source can be treated with exercises that teach our brain to rewire — giving expression to suppressed emotions and reducing the intensity of fear around pain. We need to recognize the health of our body and acknowledge the brain processes that cause pain.
Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real
Is It All in Your Head?
Medical professionals sometimes encounter chronic pain patients without a clear physical explanation and say things like "it's all in your head" or "there's no reason to invent such pain" — signaling disbelief and suggesting the patient seek help elsewhere.
Some physicians reinforce beliefs in physical problems using outdated logic — "if the back hurts, something must be wrong with the back" — strengthening patients' beliefs that their physical condition is damaged and will likely remain so for life. "Learn to live with the pain." "Avoid such-and-such movements."
They refer patients to surgeries or other invasive procedures, despite evidence showing no significant difference in outcomes between back surgery and conservative treatment (PEUL, N Engl J Med 2007; Brox Spine 2003; Osterman Spine 2006) — and no improvement from epidural injections for back pain without radiculopathy, spinal stenosis, or post-spinal surgery pain (Chou et al Spine 2009; Friedly et al N Engl J Med 2014).
What is now known beyond any doubt is that pain truly is in the brain — but not in the way you think:
Evidence shows that real pain activates similar brain regions as imagined pain (Derbyshire et al., Neuroimage 2004). Researchers also found that acute pain activates different brain regions than chronic pain — as pain becomes chronic, it activates regions linked more to emotion than to pain (Brain 2013, Javiera et al.).
Researchers have even characterized which individuals are predisposed to carry pain for a long time until it becomes chronic — based on emotional regions connected in their brains (Nature Neuroscience, Marwan et al.).
While "it's in your head" contains truth, recognize first that pain is genuinely real — observable and mappable in the brain. It is also treatable, and can completely disappear.
The basic understanding that the body is healthy and that there is no physiological cause for pain — that the main cause is neurological (originating in the brain) — gives the knowledge that these symptoms can change and heal. Overcoming pain sensations occurs through relearning and developing new neurological pathways — called PAIN REPROCESSING.
Neuroplastic Pain
Pain signals danger. Touch a heat source; your brain detects danger and transmits pain signals toward your hand, causing you to pull away and prevent injury. Sometimes these warning signals activate without actual injury.
Many current studies indicate that neural pathways in the brain can generate pain sensations without any genuine physical disturbance.
Sometimes an initial injury (fracture, trauma, etc.) produces pain from tissue damage; the brain learns this neural pathway. If pain persists after the injury has healed, it likely stems from elsewhere — not from physical sources. Tissue damage heals, but the neural pathway remains active without a physiological pain source. This is neuroplastic pain.
Right now, as I sit and you sit, we both feel sensations in our back — nerve conduction sending signals and sensations to our brain: muscle activation, the feeling of the backrest. These messages are neutral, natural, and not painful. For a person with neuroplastic back pain, these signals are experienced as discomfort and pain.
It is like a person with healthy hearing who places a hearing aid in their ear and turns up the volume. Not only don't they need the device — since their hearing is fine — but they amplify the intensity to an unbearable level.
PRT (Pain Reprocessing Therapy) aims to teach you to turn down the volume — perhaps removing the device entirely. Learning to regulate natural sensations and retraining the brain.
In my view, fear and anxiety primarily control the intensity meter. How much does the brain believe it faces danger? Pain is meant to signal danger; fear reinforces the brain's conviction — there's a place for this pain.
Chronic pain patients experience this fear constantly: "Something is surely wrong with my body," "My back is completely broken," "I'm anxious every time I sit for more than ten minutes." When the brain believes something is physically wrong — it responds with pain.
A critical treatment component is teaching the brain not to fear — teaching it that the body is fine, and that these pain signals are safe, natural physical sensations.
I'm happy to stay in touch and answer your questions.
Please leave a message and I'll respond promptly.
You can also reach me by phone, WhatsApp, or email.
- info@chronicpain.co.il
- Sdeh Yaakov
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