Predicting Pain

Imagine your brain not as a passive observer of reality, but as a prediction machine -- constantly making its best guess about what’s happening in your body and environment, and adjusting based on those guesses. This is the foundation of Barrett’s Theory of Constructed Emotion, which I introduced in my recent blog, “The Details Are Important.” And it's also a powerful way to understand chronic neuroplastic pain.

In Barrett’s view, emotions -- and by extension, sensations like pain -- aren’t hardwired reactions that live in specific parts of your brain like we've long assumed ("amygdala = fear" anyone?). Instead, they’re constructed experiences.

Your brain draws on past experiences, context, and sensory input to make meaning and create experience. Pain is one of those experiences.

How does this relate to confusing chronic pain experiences that aren't caused by ongoing injury?

Let’s say you sprained your ankle a year ago. For a few weeks or even months, pain was your brain’s helpful signal: “Something’s injured here -- time to rest & recover a bit so you don't do more harm.” But once the tissue healed, the pain should have stopped. Sometimes it doesn’t. Why?

Because your brain can learn to keep producing pain long after the risk of further harm is behind you. It has developed a prediction: “When we walk on this foot, pain happens.” So it keeps generating that pain -- not because anything is wrong, but because it expects pain, and the expectation itself creates the experience.

Over time, this pain becomes part of your brain’s internal model. Just like it predicts “this smell means coffee” or “this expression means anger,” it now predicts “this movement means pain.”

The result? Pain with no injury -- what we call neuroplastic pain.

A Short Story: The Brain That Cried Wolf

Imagine an avid backpacker who injured her back a few years ago while hiking a steep trail; let's call her Jamie. Jamie's injury was real and intense -- weeks of pain, doctor visits, physical therapy, and fear of re-injury. That’s past experience: the brain logged hiking as dangerous and painful.

Fast forward a year. Like nearly all injuries do, this one fully healed, but every time Jamie laced up her boots and hit the trail, the pain came roaring back. This wasn’t random. The context -- being on a trail, wearing the same backpack, seeing similar terrain -- acted as a signal to her brain: “This is the situation where we got hurt. Stay alert.”

Then came the sensory input: the normal tug of muscles stretching, a slight ache from yesterday’s workout, or even the pounding of her heart while climbing a hill. Harmless sensations, but through the subconscious filter of Jamie’s brain, they were interpreted as danger. “See?” her brain said, "I was right; this is dangerous."

So her brain did what it thought was helpful to slow Jamie down or stop her altogether...and to keep her safe in what it was interpreting as a potentially dangerous situation: it constructed the experience of pain.

Not because Jamie was injured, but because her brain predicted pain -- based on learned experience, the current environment, and the sensations coming from her body. It was trying to protect Jamie…even though there was no longer any injury to protect her from.

Once Jamie learned about the predictive nature of pain though, something shifted. She began approaching hiking differently: with curiosity and reassurance, calming her nervous system and steadily rebuilding new experiences of safety. Over time, those old predictions weakened and her brain updated its model.

And the pain faded.

Why This Matters

Understanding pain as a brain-generated prediction -- not just a signal from the body that means something is wrong -- opens the door to healing. If your brain has learned pain, it can unlearn it too.

Barrett’s theory reminds us that your brain is always trying to make sense of your world, using the best guesses it has. Sometimes, those guesses are simply wrong or get stuck in an unhelpful habit loop. But with the right input -- safety, knowledge, curiosity -- you can teach your brain a new story.

And your body will follow.

You can get started here for some tips on how to start teaching your brain safety around pain, breaking those old predictions, and creating more ease & comfort in your body!