The Hidden Reason Voice Use Hurts

One of the hardest voice disorder symptoms to treat is chronic pain. Some voice disorder patients experience constant throat pain. Others feel it every time they speak or after times of overuse. For some, it is their only symptom. It can present as a dull ache, stabbing or sharp pain, or a constant sore throat. Others experience tension that borders on pain. Many are given diagnoses of Muscle Tension Dysphonia or Laryngeal Hypersensitivity (also known as Irritable Larynx Syndrome). Voice therapy may or may not make a difference.

I recently learned about a mindfulness-based modality, Pain Reprocessing Therapy (PRT), that may help. The National Association of Teachers of Singing (NATS) just hosted a panel titled, “Integrating Pain Reprocessing Therapy Into Multidisciplinary Voice Care.” You can read my summary below. 

In my next my 8-week mindfulness course for people with voice disorders, I plan to include specific insights and exercises from PRT to help participants with chronic pain and muscle tension. 

WHAT IS PAIN REPROCESSING THERAPY? 
PRT is a mindfulness-based modality designed to help people overcome neuroplastic pain. Neuroplastic pain is pain that is not caused by tissue damage or a structural issue in the body. It is an unconsciously learned pattern of pain that is based in fear or similar emotions. 

Neuroplastic pain often has the following characteristics:

• originated during a stressful time

• originated without injury or lasted past the time in which the injury should have healed

• symptoms are inconsistent and worsen with stress

• symptom triggers are unrelated to the body (may be tied to specific activities, places, or stressors)

• pain has a delayed onset (begins some time after an injury)

• patient experienced childhood stress or adversity

• patient displays certain personality traits (perfectionism, people-pleasing, high conscientiousness, high self-criticism)

• lack of physical diagnosis or a diagnosis that doesn’t account for symptom severity

Neuroplastic pain is real pain. The brain generates all pain whether or not there’s tissue damage involved. Understanding the neuroplastic component simply opens up new treatment options.

PRIMARY VS. SECONDARY PAIN

It’s useful to distinguish between two types of pain: primary pain, where neuroplastic pain is the only issue, and secondary pain, where a structural problem exists as a root cause but neuroplastic processes layer on top, creating “mixed” pain. (It’s worth noting that many vocal fold “abnormalities” appear in pain-free populations.) PRT is most effective against primary neuroplastic pain, but it can reduce the severity of secondary pain as well.

THE PAIN-FEAR CYCLE

The central mechanism PRT targets is the pain-fear cycle: pain generates fear, which causes the brain to misinterpret safe signals as dangerous, producing more pain, which generates more fear. Avoidance behaviors — such as speaking or singing less — may reinforce these danger signals rather than resolving them.

WHAT DOES PAIN REPROCESSING THERAPY INVOLVE?

PRT follows five stages and participants see results in as few as 8 weeks.

1. Assess for neuroplastic pain using the indicators listed above.

2. Educate the patient about how pain develops and persists, and the importance of breaking the pain-fear cycle.

3. Gather and reinforce evidence that the patient’s condition is neuroplastic. This psychoeducation is essential for buy-in and creating a sense of safety.

4. Pain safety learning through exposure and reappraisal. This means helping patients reappraise sensations as safe, leaning into positive sensations and joy, and getting back to doing what they love.

5. Address other fears, threatening emotions, and stress to calm the nervous system overall. (Mindfulness is an excellent tool for calming the nervous system.)
   

THE 8-WEEK MINDFULNESS COURSE. One of the central practices in PRT is a mindfulness-based exercise called Somatic Tracking. I have always incorporated similar exercises into my 8-week mindfulness course for people with voice disorders. However, in the next course, I plan to include specific insights and exercises from PRT to help participants overcome chronic pain and muscle tension. The next class begins on April 12, 2026. Participation is limited. Sign up today. 

Book Recommendation: The Lost Voice by Greta Morgan

Have you ever read a book that described your own experience so completely that you finally felt seen and understood? For me, Greta Morgan's memoir The Lost Voice is that book (Amazon affiliate link). 

My story isn't exactly like Greta's. She was a successful songwriter-singer touring with a rock band when Covid triggered what would eventually be diagnosed as spasmodic dysphonia (also known as laryngeal dystonia). I was a high school student and aspiring classical singer when the flu weakened my vocal cords and decimated my high range. (You can read more of my story here.)

Still, similarities abound. Years of vocal struggles before finally receiving a diagnosis. Undergoing vocal rehabilitation. (We both worked with the wonderful Lori Sonnenberg, who specializes in rehabilitating singers with vocal injuries.) Turning to mindfulness. Pivoting to a different career path.  

Most people with a voice disorder don't know anyone with similar struggles. If this is true for you, Greta's memoir will hold a mirror to your own experience. 

So much of what Greta describes in her book reflects the themes that both I and my mindfulness students with voice disorders have lived:

• the disorienting sense that your voice has betrayed you

• a frenzied search for answers, both medical ("What's wrong and can it be fixed?") and metaphysical ("Why me?")

• an overwhelming sense of loss

• grieving the old voice

• struggling with identity and sense of self ("Am I still myself without my voice?")

• confronting social isolation

• turning to mindfulness

• settling into acceptance

• finding new purpose in living with a voice disorder

Greta's book is a poignant tale of human struggle: first, a constant striving for career success, and then a gradual acceptance of the vulnerability that a voice disorder brings. Her prose is powerfully descriptive and deeply emotional. She is a talented songwriter, after all — and she finds beauty and humanity everywhere.

One of the best parts of my mindfulness work is connecting people with voice disorders with each other while also modeling mindfulness skills that can help them cope with their condition. Greta's gorgeous memoir accomplishes a similar task in story form. And I think it's a must-read for anyone with a voice disorder. 

I love watching my mindfulness students listen to each other's voices. People who are shy about speaking up in work meetings feel comfortable talking to others who sound like them. And this brings me to my favorite thing about Greta's book: in the audio version, she reads the introduction and acknowledgements herself! As someone who loves seeing people embrace a beautifully broken voice, this touched me deeply.