Brain focusing on pain perception, surreal landscape

The Pain Game: How Your Brain's Biases Shape What You Feel

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Theo Raines in Mind & Education August 2025 • 4 min read.

"Uncover the science behind pain perception and how expectations can intensify discomfort. Learn to recognize and manage these biases for a healthier, more balanced life."


Our senses don't always give us a clear picture of reality. Sometimes we perceive things that aren't quite there—phantom movements, imagined sounds, and, perhaps most distressingly, pain without a physical cause. While these experiences can feel alarming, modern psychology reveals they often stem from something surprisingly simple: our expectations.

Expectations can powerfully shape our perception. This concept has been highlighted in a recent study in Nature Human Behaviour by Jepma and colleagues, showing the way our expectations about pain influence how we learn about and ultimately perceive it. The findings reveal that we tend to prioritize information confirming what we already believe, creating a self-perpetuating cycle of biased pain perception.

This research shows that the relationship between expectation and pain isn't just about what we perceive in the moment; it's about how our brains learn and adapt, and the biases that can creep into that learning process. Understanding these biases is the first step toward managing them, offering hope for those struggling with chronic pain and related conditions.

The Predictive Brain and the Persistence of Beliefs

Brain focusing on pain perception, surreal landscape

The idea that perception is heavily influenced by expectations is well-established. Theories like 'perception as inference' or predictive coding suggest that our brains constantly make predictions about the world. These predictions then guide our perception, favoring interpretations that align with what we anticipate. This becomes particularly intriguing when considering how persistent these expectations can be, even when proven wrong.

This persistence isn't just a matter of perception; it extends to how we learn. Our expectations can directly influence processing of sensory information in sensory cortices and higher-level brain regions. Jepma and colleagues explored this interplay using computational modeling and functional neuroimaging. Participants were conditioned to associate visual cues with different levels of heat, then exposed to a test phase where cues were mixed. The study tracked participants’ expectations, pain intensity ratings, and brain activity.

Key findings from this research include:
  • Higher Pain Expectation: Higher pain expectations led to higher pain ratings and increased activity in pain-processing brain regions, reinforcing the idea that expectations directly influence our perception of pain.
  • Selective Evidence Processing: Participants selectively adjusted their expectations based on previous experiences.
  • Confirmation Bias: This resulted in a confirmation bias, where participants learned more from information confirming their expectations and ignored conflicting evidence.
  • Neural Basis: Brain regions involved in anticipatory anxiety and threat showed engagement during stimulus anticipation, scaling with the confirmation bias.
Through sophisticated analysis, Jepma’s team demonstrated that altered perception combines with biased learning. Expectations reflect prior knowledge, which can be wrong if information is lacking or circumstances change. When our experiences don't match expectations, we should adjust our thinking. However, the study revealed that we don't always treat all evidence equally. We tend to create a perception molded to our expectations, akin to a self-fulfilling prophecy. This confirmation bias is rooted in brain regions associated with threat, anxiety, and affective value, influencing subsequent perception.

Implications and Future Directions

The authors suggest these findings have implications for patients with chronic pain and other conditions, such as anxiety and depression, where maladaptive perception and learning are common. However, the results also suggest a potential upside: the confirmation bias can favor the perception of less pain, as seen in placebo treatments. Understanding how to harness our eagerness to confirm expectations could lead to better interventions.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1038/s41562-018-0468-3, Alternate LINK

Title: Biased Perception And Learning In Pain

Subject: Behavioral Neuroscience

Journal: Nature Human Behaviour

Publisher: Springer Science and Business Media LLC

Authors: Katja Wiech

Published: 2018-10-29

Everything You Need To Know

1

How do expectations influence pain perception, according to the research?

According to the research, higher pain expectations can lead to increased activity in pain-processing brain regions and consequently, higher pain ratings. This indicates that what you anticipate feeling significantly influences your actual pain perception. Jepma and colleagues demonstrated this link through computational modeling and functional neuroimaging, showing that expectations directly influence the perception of pain.

2

What is the 'confirmation bias' in the context of pain perception, and how does it work?

The research by Jepma and colleagues highlights the presence of a confirmation bias in pain perception. This means that we tend to prioritize and learn more from information that confirms our existing expectations about pain, while downplaying or ignoring evidence that contradicts them. This bias is rooted in brain regions associated with threat, anxiety, and affective value, reinforcing the self-fulfilling prophecy of pain perception.

3

Can you explain the idea of 'perception as inference' and how it relates to expectation and pain?

The concept of 'perception as inference' or predictive coding suggests that our brains are constantly making predictions about the world, and these predictions heavily influence our perception. Our brains favor interpretations that align with what we anticipate, leading to a biased perception. This persistence of expectations extends to how we learn, influencing the processing of sensory information and reinforcing our pre-existing beliefs, even when those beliefs are inaccurate or unhelpful.

4

In what way can understanding biases in pain perception lead to better pain management, such as with placebo treatments?

The confirmation bias identified in the study can favor the perception of less pain, as seen in placebo treatments. Placebos work by creating an expectation of relief, which can then reduce the perceived intensity of pain. Harnessing our natural eagerness to confirm positive expectations could lead to more effective interventions for managing pain and other conditions. This approach could be particularly beneficial for individuals with chronic pain, anxiety, or depression, where maladaptive perception and learning are common.

5

What are some practical steps individuals can take to manage the biases that shape their perception of pain, according to the findings?

To manage pain perception biases, it's essential to become aware of how expectations shape experiences. Techniques such as cognitive restructuring can help challenge and modify negative expectations. Additionally, mindfulness practices can improve awareness of the present moment, reducing the influence of anticipatory anxiety and threat. By understanding how the brain learns and adapts, individuals can actively work to break the cycle of biased pain perception.

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