Part 2: Our Helicopter Brains and Their Unfortunate Habit of Predicting Pain

Caroline J Davies

Read about how predicted pain works and why Pain Reprocessing Therapy makes sense as a way to deal with it.

In Part 1: How Our Helicopter Brains Learn to Predict Everything We Feel and Do, I explained how our brains, over time, learn to predict almost everything we feel and do, and how they turn into our very own personal helicopter parents. Now we are going to make sense of how our brains also predict pain, how this explains why we get stuck in chronic pain, and why a pain reprocessing approach makes sense as a way to get out of pain. First, a reminder of why our helicopter parenting brains are in charge of pain and what they use pain for.

How the smartest “person” in the room gets our attention

It turns out that our brains predict, manufacture, and distribute pain for us ¹, “sending” it around our bodies, not only when we are physically injured but, also, when we are mentally or emotionally threatened. In fact, our brains issue this pain alarm even when they just think we might be under threat, all to get our attention to the problem at large, as shown in the picture above.

Although it’s unlikely that the person in the picture would miss such a crater-like pothole, what if this actually represents the memory of the pothole they did step in last year- that they have just spent a year trying to recover from. Or what if it is more of a proverbial pothole their brains are trying to warn them of. A difficult boss they are going to deal with, or colleagues who are undermining all their efforts to improve things. They might be on their way home to a difficult second carer role, troubled kids, or a disappointing relationship. They might have just found out they are being laid off and this hole represents their unknown and scary future. All of these things are possible threats, and our brains have a duty to warn us about them, and if they think we might not be paying enough attention, they will include pain in these warnings.

If you haven’t yet heard that our brains are in charge of pain then I encourage you to also read Five Questions About Pain That You Might Not Have Thought to Ask . It is trippy enough to think about predicted pain, without having to also take on the new idea of pain being created in our brains. If you are still not sure, ask yourself this question: who else would you want to be in charge of pain, if not your very own brain, with its 86 billion neurons and trillions of possible connections between them, that has also been in every room with you throughout your whole life?

How does this predicted-pain-thing work?

How do our brains include pain with all the other predicted programmes we are running? Think of your brain as if it were an orchestra, made up of many musicians and instruments being played, and the percussionist (playing the drums) is playing the role of pain in our brains. It’s clear that they have an important warning role, those drums will get our attention. What we don’t realize is that the drumming is already written into certain of the musical scores, where threatening things are on the horizon. In the same way, the brain has pain written into the predicted programmes for those parts of our lives that were indeed threatening at one point, or we still feel threatened by now.

The different patterns of instruments being played in any piece of music represent the different patterns of brain neurons (nerve cells) firing (transmitting messages) in our brains. We have predicted programmes for anything we do or experience regularly, all our daily routines and exercise and all our work and family habits. The ways we have of thinking and feeling in between, do tend to be quite predictable too! For any of these predicted programmes there will be neuron firing patterns (like the musical scores) that represent the movements of our body, the positions of our limbs, the balance involved, and most importantly, what all these things will feel like, including how we might feel internally or emotionally. Finally, as we have in the example of the orchestra above, there will be some predicted programmes that include a range of painful feelings from light to very heaving drumming.  

Let’s get into a real example to make some more sense of this idea of predicted pain…

Sitting is Painful: An Example of Predicted Pain

Imagine, the person below just showed up at an event, and as they noticed what kind of chairs they were going to have to sit in, their heart sank. For the last year they have been struggling with back pain, and sitting in chairs like these has always made it worse. What kind of experience do you think their brain is predicting as they walk in to take their seat? Not a good one, you might guess.

Even before they sit down, their back has started aching. Their brain will already be predicting the remembered programme of painful feelings that have come with sitting in these types of chairs. Alongside this, they will be worriedly thinking things like, how long will this event last, I wonder if I can stand at the side, have I got time to dash out and get my cushion from the car? It is highly unlikely that they will be making themselves notice what actually happens as they sit down, and what sensations they actually feel; instead, their predicted programmes will be in full flow. Unless they have started doing Pain Reprocessing Therapy, which we will come back to, shortly.

Ironically, our brains don’t know that chairs are an everyday part of our modern lives, not a monster that we can avoid forever, as long as they keep warning us about it. Can you see how much of a problem predicting pain then becomes? Even if your back has already healed weeks, months or years ago, your brain can still be running those, now out of date, pain programmes. And our brains are very easily suggestible too, notice if your back has started aching at all while just reading this story, whether you started off sitting comfortably or not, mine has!

Pressing Q&A’s

Q: Isn’t my brain predicting pain because it is painful to sit in chairs?

A: Well, up to a point that is true, if you just sprained a muscle in your back, pulled some ligaments, or even fractured a bone, it may be very useful for your brain to remind you, through pain, that sitting is not the best position for you right now, especially in an unsupportive chair. But even if the worst happened and you had fractured your spine, your bone would have healed after 12 weeks, so a year later, you “should” be able to sit without pain. The problem is that sitting was painful to start with, and this is how your brain got stuck in that automatic programme of predicting pain with sitting.

Q: Are you saying I am doing this pain-thing deliberately?

A: It’s especially important that when we talk about predicting pain, we must also say that this is not something we consciously do or ever intend to do. Remember how hard it is to catch any moment where we might notice our brains predicting things, it happens as seamlessly as any other routine thing we do. Do we notice our brains predicting how to take out the bins without spilling the contents along the way, how to ride a bike without falling off, or how to walk when the pavement is slippery?

Q:If we can’t help predicting pain, how do we then stop our brains from doing it?

A: In discovering the hidden lives of our brains secretly predicting our pain, therein also lies the potential to stop it doing so. And that is where Pain Reprocessing Therapy steps in.

Q: How do we notice anything new if we are always predicting everything?

A: Although we are big predictors, our brains do notice quickly if something doesn’t match our predictions, this in fact is another way you can think about doing pain reprocessing, you provide a prediction error for your brain, starting to change its’ predictions.

How pain reprocessing works to change our pain predictions

Although rare these days, we do sometimes come across TV channels running old shows, they can be nostalgic to watch and the comedies can get funnier over time, because you know exactly what is going to happen next. But no one wants to see outdated pain shows over and over again, which is exactly what our brains do to us when we get stuck in chronic pain.

Now we are beginning to understand how much our brains are involved with pain— even predicting it— it starts to make sense that reprocessing or reprogramming our brains would be key to getting out of pain. There are a few key steps to pain reprocessing which are as follows:

Understanding Pain: Going back to our orchestral analogy above, understanding pain is like understanding the role of the drums, they are not just there to annoy or frighten you, or make your life difficult, but to warn you of a problem or threat, physical or emotional. And they might still be drumming even though the threat is over.

You are already rewriting or rewiring your brain by reading these articles. This is the first step of Pain Reprocessing Therapy, really understanding pain and how the brain can get stuck, predicting it. In turn, you might be starting to feel less afraid of the pain.

There’s also a lot of unlearning to do, especially if you have seen a lot of different health professionals or been through a lot of different procedures or even surgeries. You may well have been given some scary-sounding diagnoses or spurious reasons for your pain, which your brain might have found even more threatening, unfortunately further increasing your pain.

I have done this earlier in my career too; most medical providers were not taught this pain science in college, but we were trained to come up with diagnoses and explanations; when we really didn’t know what was causing pain, it would still feel better to come up with some reason for it, than none. Likewise, if it’s a good explanation and comes with a simple therapy to deal with it, this might be enough to have convinced your brain to turn off the pain alarm anyway, even if the given explanation or therapy was not the actual cause or remedy needed.

Pain Insights: In an orchestra, if the drummer represents threats, it might be good to at least consider what the drummer is worried about, maybe there is something you have missed?

 As long as you have ruled out actual damage or harm, the next way to help your brain “downgrade the pain” is to start the reflective process of looking at all the reasons you might be in pain right now, or why it might have started, or what it might really be all about. This not only softens the drummer’s blows but also helps you to understand why your pain appeared in the first place and what you were or might still feel threatened by in your life. This can lead to real steps being taken, to address any remaining threats, or reassuring your brain that they are now indeed over, and what is happening is “just” a very unfortunate “Habit of Pain”² your brain got into.

Pain Reprocessing (Somatic Tracking): In the orchestral analogy, pain reprocessing would be like: sitting next to the drummer and giving them reassurance that everything is OK; appreciating them by listening to their drumming but not being alarmed by it, helping to also calm them down; being patient and understanding with the drummer and doing this every day for a while. Over time their incessant drumming slowly wavers and fades out, as the drummer also realizes the threats are in the past and they can now take a well-earned break.

Some people think of this as being the main part of Pain Reprocessing Therapy, but people can get better just by doing the first steps mentioned above, educating themselves about pain. This pain reprocessing part of the therapy, for various reasons not to delve into here, doesn’t always work for everyone either.

With those caveats out of the way, let’s further explain how this stage of Pain Reprocessing Therapy does reprogramme or rewire your brain and its’ predictions.

The following model is another way of explaining pain reprocessing, turning pain into sensations: taking the pain out of the “pain” box and putting it into the “sensation” boxes, first the “painful sensations” box and then, over time, the “normal sensation” box. ³ This is further explained below the diagram.

1. PAIN Box: imagine you have back pain, like this gentleman above, you always feel it when you lean back, it just hurts without you even thinking about it (this is predicted pain).
2. Painful SENSATIONS Box: slow things down and catch out your brain by noticing— in real time— exactly what painful sensations or other sensations you can feel, moment by moment. This is also called Somatic Tracking. This confuses your brain and its normal predictions, creating a prediction error, if you will. Your brain might continue to create pain, but you might notice it scrambling around a bit, moving the pain to a new spot or changing the nature of it. All this is to be welcomed, you are putting a spanner (wrench) in the works of your predicted habits of pain.
3. Normal SENSATIONS Box: with practice and some patience, just like learning a new instrument, language, job, or sport, you will notice the normal sensations that come with bending your back, instead of the painful ones. It takes time to retrain our brains.

This last step is significant, because your brain might have been busily interpreting the normal sensations of, a not always comfortable life, as painful ones. Taking it back to the example above of the person sitting in the chair, it is worth saying, those chairs are not comfortable!

Now we have the insights we need into our brains and their unfortunate habit of predicting pain, what might we still be missing from the picture. Our emotions, perhaps?

Footnotes:

1. https://www.sciencefocus.com/the-human-body/how-your-brain-creates-pain-and-what-we-can-do-about-it ↩︎
2. Another great phrase a patient introduced to me, as their way of understanding their pain
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3. Thank you to another insightful patient for explaining how they made sense of Pain Reprocessing Therapy with this model ↩︎