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Pain as a predictive process in the brain: how the Bayesian brain generates, amplifies, and relieves pain.

Pain is not a passive readout of nociceptor traffic; it reflects the brain's inference about bodily threat under uncertainty. Building on predictive processing, active inference, and the free energy principle, we frame acute, chronic, and phantom pain as regimes of hierarchical inference in which memory, affect, and context shift the relative influence of prior beliefs vs incoming nociceptive evidence. Prior work links expectations to pain, but translating these ideas into a clinically usable account that links expectation mechanisms to measurable proxies of belief updating and to principled r…