Understanding Pain Through Prediction and the Sensory System
“The context is the framework that gives emotions a reason for happening because it describes what occurs around a person.”
I’m diving into a fascinating subject—one that might change the way you think about learning, pain, and how we interpret the world around us.
I want to explore how we process sensory information and how this relates to pain, based on the work of psychologist Lisa Barrett-Feldman. Her research emphasizes context, something that we, as manual therapists, use everyday with each of our clients. Context shapes emotions, memories, and experiences, which play a crucial role in how we respond to treatment and recover from pain.
Let’s start with the brain. It’s a fascinating organ—trapped in a dark, silent box (your skull) floating in a clear fluid. The only information it gets about the outside world is through electrical signals—sights, sounds, touch and more—sent by your sensory system. These signals aren’t inherently good or bad; they’re just data that the brain interprets.
Here’s where it gets tricky. The brain uses past experiences and context to make sense of these signals. It creates predictions based on what it expects to happen. When reality matches that prediction, we feel safe and in control. But what happens when it doesn’t?
Here’s an example.
Could you easily understand what was said? Click below to see what was said.
Now, play it again.
Your brain predicted what it expected to hear based on the new context I provided, and now you “understand” the speech.
Here is another example.
Stand up
Close your eyes
Sit back down.
Did you fall? Your brain successfully predicted the location and height of the chair because of your past experiences. You didn’t even need to see it to know where it was. This process is not something new to us. It is known as learning—built on prediction and repetition.
But here’s the twist: what happens if the prediction is wrong?
Think back to an experience with a sibling or childhood friend. You may both remember the same event but with different details. Why? Because each of you predicted what you thought would happen, and even if the sensory data didn’t fully align, your brain stored that memory as if it was correct. This happens all the time, and it happens because the brain prioritizes efficiency over accuracy.
Imagine hearing this.
What did you hear?
People have told me this sounds like popcorn, a typewriter, a wood pecker, a gun shot, fireworks, etc. In reality, it could be any of those. What did your brain think it was? What context did your brain create to justify that sound? Your brain creates a prediction based on the context you’re in. If you feel safe, you might guess “fireworks” or “popcorn.” If you feel unsafe, it could be “gunfire.” The context shapes how we interpret sensory input, even if it's wrong.
Your brain’s top priority is metabolic efficiency—staying alive with the least amount of effort. This can work against us when it comes to pain. Let’s say you have chronic low back pain. If your brain predicts that a certain movement will cause pain, it’s easier (and more efficient) to experience that pain even if the physical stimulus suggests otherwise. In other words, your brain allows for a pain hyper sensitive response to occur because it expects it.
Here’s the important takeaway: we need to be active, not passive, in how we approach pain and healing. If your clients simply accept their brain’s prediction of pain, they’re more likely to continue experiencing it. The solution? Encourage them to be concious of those predictions and validate if there is a significant enough mismatch to adjust ones predictions.
Let us use the image below as an example:
Once your brain sees the second image it is quite clear your prediction of what the face in the image will look like is wrong, yet if you look at the first image again your brain will still predict what a ‘normal’ face will look like and not the actual image.
So what do we do with this information? How does it help us with clients?
Have them keep a journal. Write down what hurts, when it hurts, and how it feels. Be specific. The act of pausing, reflecting, and describing their symptoms helps interrupt the brain’s automatic predictions and forces a more accurate evaluation of what’s happening. This active engagement is essential for changing the brain’s story, especially when dealing with chronic pain or trauma.
Make the mismatch, match!
Understanding how the brain predicts and processes sensory input gives us a powerful tool in treating pain. While it’s tempting to let the brain take the easy route—confirming predictions with little effort—being mindful and proactive can rewrite those patterns. It takes energy, mindfulness, and time, but the payoff is worth it. You can help your clients take control of their recovery by teaching them to challenge their predictions and create a new narrative for their body and mind.
It’s a lot of work, but it’s work that leads to healing.