Can You Retrain Your Brain Out of Chronic Pain? The Moskowitz-Golden Approach
How two pain specialists used neuroplasticity to reverse chronic pain — and how the technique works.
In 1994, Dr. Michael Moskowitz was water-skiing with his daughters when he fell hard, his neck bent backward. The pain that started that day would last thirteen years.
Moskowitz was already a well-credentialed pain specialist — board-certified in both psychiatry and pain medicine, an assistant clinical professor at the University of California, and an examiner for the American Board of Pain Medicine. He tried every treatment available. Nothing worked.
Then one of the many doctors he consulted told him something that changed his life: the pain wasn't stemming from physical damage anymore. His brain had learned to produce pain.
That insight launched what would become the Neuroplastic Transformation approach — a clinical framework developed by Moskowitz and his colleague Dr. Marla Golden, DO, that uses the science of neuroplasticity to reverse chronic pain. Within a year of applying it to himself, Moskowitz was almost entirely pain-free. He has spent the years since teaching the approach to other patients — many of whom, according to case reports documented by Dr. Norman Doidge in The Brain's Way of Healing, have achieved similar results.
This article breaks down what Neuroplastic Transformation is, how it works, what the MIRROR method actually looks like in practice, and how to apply it if you want to try.
NPA QUICK READ — 60 SECONDS What is Neuroplastic Transformation? A brain-based approach to chronic pain developed by Dr. Michael Moskowitz, MD (pain and psychiatric medicine) and Dr. Marla Golden, DO. It applies neuroplasticity science to reduce or eliminate persistent pain through structured mental practice and body-based work. How it works: Chronic pain physically expands the brain's pain-processing regions. The approach uses "competitive plasticity" — the brain's use-it-or-lose-it rule — to shrink those regions back and reclaim territory for non-pain activity. The MIRROR method: Motivation, Intention, Relentlessness, Reliability, Opportunity, Restoration — the six-part framework Moskowitz uses to teach the practice. Timeline: First results within 4–6 weeks of relentless daily practice. Full transformation typically takes months to a year. Not a quick fix. Genuinely effective for many. |
Pain That Lives in the Brain, Not the Body
To understand Neuroplastic Transformation, you first need to understand what chronic pain actually is.
There are three types of pain:
• Nociceptive pain — the ordinary pain of injury. You cut your finger, you feel pain. Nerve receptors called nociceptors send a signal to the brain.
• Neuropathic pain — pain from structural damage to the nervous system itself, from injury, stroke, diabetes, or other causes.
• Neuroplastic pain — pain that persists after the original cause has healed, because the brain's own pain-processing networks have been physically restructured.
This last category is what Moskowitz was living with. And it's the key insight underlying everything that follows.
Landmark research by Dr. Clifford Woolf and others has documented that persistent pain physically changes the brain. Regions responsible for processing pain — including parts of the somatosensory cortex, anterior cingulate cortex, and insula — grow in size and take over territory that used to handle other functions. It's the same mechanism that lets a violinist grow the brain region for finger control. Repetition builds circuitry. When the repeated signal is pain, the pain circuit grows.
This is why chronic pain often keeps hurting long after any physical cause has resolved. And it's why the brain — not the injury site — is where the treatment has to happen.
Competitive Plasticity: The Use-It-Or-Lose-It Rule
Neuroplastic Transformation works by applying one of the best-established principles in neuroscience: competitive plasticity.
Neurons compete for territory in the brain. Whatever gets used most, expands. Whatever gets used least, shrinks. When part of the brain becomes devoted to processing chronic pain, that expansion comes at the expense of other functions — which is why so many people with chronic pain also experience cognitive fog, mood changes, and reduced coordination. The pain map is literally taking over.
Moskowitz asked a straightforward question: what if the same rule could work in reverse? What if you could deliberately give the non-pain regions of the brain something else to do — something so consistent and so relentless that they took their territory back from the pain map?
The answer, based on his own thirteen-year recovery and the patients who have followed him, appears to be yes.
The MIRROR Method
Moskowitz developed the acronym MIRROR to describe the six components required for the approach to work. This is the framework:
M. Motivation. The patient must take responsibility for their own healing. Nobody else can do the mental practice for you.
I. Intention. You have to actively want the pain to end — which sounds obvious, but chronic pain often becomes so central to identity and daily life that some part of the mind resists letting it go.
R. Relentlessness. Every time pain fires in your consciousness, you meet it with the practice. Every single time. Moskowitz writes: "Anytime pain intrudes on consciousness, it is greeted with visualization."
R. Reliability. Do the practice the same way, every time, so the brain gets a consistent signal that this new pattern is real.
O. Opportunity. Every pain flare becomes an opportunity to practice — not a setback.
R. Restoration. The goal is not just less pain. It is the return of normal function — movement, cognition, mood, connection — in the brain regions the pain map had colonized.
The MIRROR framework isn't the technique itself. It's the mindset required to sustain the technique long enough for neuroplastic change to occur.
How to Apply It — The Visualization Practice
The core technique is a specific form of visualization. Here is how Moskowitz teaches it, step by step.
Step 1 — Learn what the pain map looks like
Moskowitz's clinical work uses actual brain images — diagrams showing the pain-processing regions of the brain highlighted in yellow, indicating heightened activity. Patients study these images until they can picture them clearly from memory.
The three images most commonly used are freely available on the Neuroplastix website (neuroplastix.com). Moskowitz recommends spending time looking at them until you have a vivid mental picture of what an active pain map looks like inside your own head.
Step 2 — Prepare a "transformation" image
Alongside the pain-map image, prepare a mental picture of what your brain would look like without the pain map — the yellow zones shrinking, the healthy tissue expanding back into its normal size.
Some people use the actual Neuroplastix brain slides for this. Others create their own mental imagery. What matters is that you have a clear, consistent picture of the pain map shrinking and healthy brain function expanding.
Step 3 — The moment the pain fires, meet it
This is where MIRROR's Relentlessness principle becomes concrete. Every single time you notice pain — no matter how small, no matter how brief — you immediately call up the visualization.
Picture the yellow pain-map regions shrinking. Picture the healthy tissue expanding. Hold the image with focus, briefly but vividly, until the moment passes.
Do this every single time. Not just when the pain is bad. Every time it fires at all.
Step 4 — Be prepared for the timeline
Moskowitz is unusually honest about the pace of change. The first few weeks are the hardest — the practice feels endless, and the results are subtle. Most patients start noticing small pain-free windows around the four-to-six-week mark. These windows lengthen with continued practice.
Doidge, describing Moskowitz's patients in
The Brain's Way of Healing, compares the process to learning a musical instrument or a new language: difficult at first, gradually easier, requiring months to a year of consistent practice for full transformation.
What matters is that you don't stop. Chronic pain wired itself into your brain through relentless repetition. It comes out the same way.
Step 5 — Add body-based work
Dr. Marla Golden's contribution to the approach uses touch, sound, and vibration in the body — the same competitive-plasticity mechanism, applied through different sensory channels. Golden is trained in osteopathy and developed a technique she calls Fascial Body Manipulation, aimed at using pleasurable body sensation to counteract the persistent pain signal.
For self-directed practice, this can look like: intentional physical movement you enjoy, gentle self-massage, warm baths, focused attention on pleasant physical sensations. The principle is the same as the visualization — give the brain a consistent, competing signal to the pain.
Where to Watch Dr. Moskowitz Explain It Himself
For anyone who wants to hear the approach directly from Moskowitz, the single best resource is a one-hour presentation he delivered in 2016 titled Neuroplastic Transformation: Using Neuroplasticity to Cure Persistent Pain.
In this talk, Moskowitz walks through the neuroscience of chronic pain, the mechanism behind Neuroplastic Transformation, and the practical steps of the approach. It's the clearest full explanation available anywhere online, in his own voice.
Where Neuroplastic Transformation Fits in the Broader Picture
Moskowitz and Golden's work isn't the only neuroplasticity-based approach to chronic pain.
The last decade has seen a wave of related treatments emerge, all working on the same underlying principle: chronic pain is a learned brain response, and the brain can unlearn it.
• Pain Reprocessing Therapy (PRT) — developed by Alan Gordon and studied at the University of Colorado Boulder. A 2022 study published in JAMA Psychiatry (Ashar et al.) found that 66% of chronic back pain patients were pain-free or nearly pain-free after PRT treatment, with results lasting at one year.
• Cognitive Behavioral Therapy for chronic pain — the most researched non-pharmacological treatment, with documented brain-imaging changes in pain-processing regions after successful treatment.
• Virtual Reality for chronic pain — FDA-authorized (RelieVRx) in November 2021 for chronic lower back pain. Uses immersive experience to interrupt pain circuits.
• Graded motor imagery and mirror therapy — originally developed for phantom limb pain, now used for a range of chronic pain conditions.
What connects all of these is the reframe of chronic pain as a brain condition, not just a body condition. Neuroplastic Transformation was one of the earliest clinical applications of this principle, and remains one of the most fully-developed.
Getting Started
If you want to try the approach yourself, here is the practical starting point:
1. Read chapter one of Dr. Norman Doidge's book
The Brain's Way of Healing. This is where most people first encounter the approach, and Doidge explains the science and case histories in accessible detail.
2. Visit neuroplastix.com. This is the doctors' own site, with brain animation slides, videos, and information about the approach.
3. Watch the Moskowitz 2016 presentation. It gives you the full framework in his own voice.
4. Get the Neuroplastic Transformation Workbook by Moskowitz and Golden. This is the doctors' own written guide to the practice, designed for both self-directed use and for use with a clinician.
5. Consider finding a clinician trained in the approach. Neuroplastix.com maintains referral information, and many pain psychologists and functional medicine practitioners are now trained in related neuroplastic approaches.
A note on realistic expectations: Neuroplastic Transformation isn't a cure-all, and it isn't right for every kind of pain. Moskowitz himself has been clear that the approach works best when the pain is genuinely neuroplastic — that is, when the persistent signal reflects a learned brain pattern rather than active tissue damage. If you're not sure whether that applies to your pain, that's a conversation for a qualified pain specialist. And this approach is not a replacement for medical care.
Frequently Asked Questions
How long does the practice take to work?
First noticeable improvements typically appear at four to six weeks of consistent, relentless daily practice. Fuller transformation usually takes several months to a year. Moskowitz himself became mostly pain-free within a year of starting his own practice, after thirteen years of chronic pain.
Is this just placebo?
This is a fair and common question. Doidge, Moskowitz, and other researchers cite documented brain-imaging changes as evidence that measurable neuroplastic changes occur — not just subjective pain-rating changes. The mechanism (competitive plasticity) is one of the most well-established findings in neuroscience. That said, the approach is unlikely to work if you don't fully commit to it, which is one reason MIRROR emphasizes motivation and intention so strongly.
Does it work for fibromyalgia?
Moskowitz himself has stated that fibromyalgia is one of the conditions most responsive to Neuroplastic Transformation, provided the patient can commit to the relentless practice. He and Dr. Golden have reported strong results with a wide range of chronic pain conditions including fibromyalgia, chronic back pain, complex regional pain syndrome, migraine, and neuropathic pain.
Can I do this without a therapist?
Yes. Many patients work with the Neuroplastic Transformation Workbook independently. That said, working with a clinician trained in the approach can help — particularly for troubleshooting when the practice feels stuck, and for combining the visualization work with body-based Golden techniques.
What's the difference between this and Pain Reprocessing Therapy (PRT)?
They share the same underlying principle: chronic pain is a learned brain response, and the brain can unlearn it. The techniques differ. PRT (developed later, by Alan Gordon and colleagues) uses "somatic tracking" — attending to the pain sensation with curiosity and safety rather than fear — to break the pain-alarm cycle. Moskowitz's approach uses active competitive visualization. Both are neuroplasticity-based. PRT has been more formally studied in randomized trials; Moskowitz's approach has more real-world case documentation over a longer period.
What if the pain is coming back?
Flares are normal and expected, especially in the early months. Moskowitz's guidance is straightforward: treat every flare as an opportunity to practice. The neuroplastic change happens through repetition. A flare that gets met with the visualization is a chance to reinforce the new pattern.
Is this covered by insurance?
If you're working self-directed with the workbook, there's no cost beyond the book itself. If you're working with a clinician trained in the approach, coverage depends on your provider and insurer. Neuroplastix.com has referral information.
Is this safe?
The core practice is a form of directed mental attention. There are no medications, no procedures, and no physical interventions. It should not be used as a replacement for medical care, particularly if new symptoms emerge — pain can also be a signal of new tissue damage that needs medical attention. Anyone with chronic pain should be under the care of a qualified healthcare provider.
Key Takeaways
• Chronic pain physically restructures the brain — pain-processing regions expand, and this is why pain persists after tissue heals.
• The Moskowitz-Golden Neuroplastic Transformation approach uses competitive plasticity to reverse this: shrinking the pain map, restoring normal function.
• The MIRROR framework (Motivation, Intention, Relentlessness, Reliability, Opportunity, Restoration) is the mindset needed to sustain the technique.
• The core practice is visualization — meeting every pain moment with a mental image of the pain map shrinking and healthy brain regions expanding.
• Results typically begin in 4–6 weeks of relentless daily practice. Full transformation takes months to a year. This is not a quick fix — and for many, it works.
References
Doidge, N. (2015). The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity. Chapter 1. Viking Press.
Moskowitz, M. H., & Golden, M. D. (2013). Neuroplastic Transformation Workbook. Neuroplastix / Neuroplastic Partners LLC.
Neuroplastix.com — official website of Drs. Moskowitz and Golden, including brain-map slides, animations, and clinical resources.
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15.
Ashar, Y. K., Gordon, A., Schubiner, H., et al. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry, 79(1), 13–23.
Moskowitz, M. H. (2016). Neuroplastic Transformation: Using Neuroplasticity to Cure Persistent Pain. Presentation, International Awareness Days for ME/MCS/Fibromyalgia/CFS. eleanorsteinmd.ca.
Parks, E. (2020). Six Steps to Rewire Your Brain and Master Pain. Psychology Today, October 30, 2020.
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