Why Your Pain Might Be Real, Even If Tests Say Otherwise
Understanding the predictive brain and persistent pain
At Core Clapton, we see many patients who come to us with ongoing aches, pains, and fatigue that don’t quite fit into neat diagnostic boxes. Blood tests and scans often come back “normal”, yet the discomfort persists. It can feel frustrating, even demoralising.
But there’s a new way of understanding these kinds of symptoms, one that doesn’t dismiss your experience, but instead explains it in a more complete and compassionate way. And the key lies in how your brain predicts what your body is feeling.
Your brain: not just a receiver, but a constructor
We tend to think of our brains as simply reacting to the world around us: you touch something hot, you feel pain. But that’s only part of the story.
Modern neuroscience suggests that your brain is constantly making predictions, about what you’ll see, feel, hear, and even how much pain you’ll be in. In most cases, these predictions help you function smoothly. But sometimes, especially when pain has been going on for a while, your brain can start predicting pain even when your body is no longer in real danger. And because these predictions are so powerful, they can shape what you actually feel.
When the Body is Fine, But the Pain Feels Real
This is what doctors now call functional neurological disorder or functional symptoms. They're very real and often deeply distressing. But they don’t show up on scans or blood tests because they’re not caused by physical damage to your tissues or nerves. Instead, the issue lies in how your brain is interpreting signals, and how it's weighing those signals against your expectations and attention.
A classic example is something called a tubular visual field defect, where a person sees a blind spot in their vision that’s physically impossible according to the laws of optics. The brain, it seems, is predicting a visual gap, and the person experiences it, even though there’s no structural problem with the eye.
The same kind of thing can happen with tremors, paralysis, and chronic pain. And again, it’s important to say: this doesn’t mean you’re imagining it, exaggerating, or “making it up”. It means your brain is doing its best, but it’s got stuck in an unhelpful loop.
The role of attention and hidden expectations
Let’s take chronic back pain, something many of our patients experience. You might start with a legitimate injury, say, from lifting something awkwardly or a fall. But after that injury heals, the pain doesn’t go away. In fact, you start to expect pain when you go up stairs or bend down to tie your shoes.
Over time, those expectations become so ingrained that they shape what your brain pays attention to, and the result is that the pain feels just as real, even if there’s no longer anything physically wrong. One Hackney-based health psychologist put it this way: “You no longer need the injury to feel the pain.”
This is also why people with long-term conditions like asthma or fibromyalgia can experience symptoms that don’t always match what’s happening in the body. It’s not in their head, it’s in their brain’s predictions.
How can you break the cycle?
There’s now growing evidence for treatments that gently challenge and shift those stuck predictions. One approach, called Pain Reprocessing Therapy, focuses on helping you understand that your pain, while completely real, might not mean that damage is still occurring. It encourages small, supported movements, even ones you might normally avoid, so your brain can learn that movement doesn’t have to equal harm.
Other techniques involve redirecting attention, using mindfulness, body awareness exercises, or even guided touch and movement therapies like osteopathy.
A key part of all this is education. When people truly understand that their symptoms are real but potentially reversible, something powerful happens: the brain starts to update its expectations. And that’s when change becomes possible.
What this means for you
If you're someone living in Hackney who’s been managing niggling back pain, unexplained fatigue, or recurring tension that no one seems to explain, know that you're not alone. And more importantly, know that what you're feeling is real.
At Core Clapton, we take this seriously. Our osteopaths and practitioners are trained to consider not just muscles and joints, but also how your brain, body, and lived experience all interact. We’re happy to talk with you about how this science applies to your symptoms, and how small, supported shifts, both physical and mental, can help rewire your experience of pain.
Because sometimes, healing doesn’t start with a scan. It starts with a new way of understanding what your body is trying to tell you.
References
Clark, A., 2024. Hacking the predictive mind. Entropy, 26(8), p.677. Available at: https://doi.org/10.3390/e26080677 [Accessed 5 Jun. 2025]
