A significant proportion of patients with severe chronic pain are also carrying something older. Not always a single catastrophic event — often a childhood, a period, a relationship. And the two are not filed separately in the nervous system.
This article is about a specific and frequently misunderstood piece of neuroscience, and about what it can and cannot do for someone in pain.
Memory is reconstructive
The intuitive model of memory is a recording: an event happened, it was stored, and remembering plays it back.
That is not how it works. Retrieving a memory makes it temporarily labile, and it is then re-stored — a process called reconsolidation. What gets written back is influenced by the state you were in when you retrieved it. Over years, a memory recalled many times in distress is not the original event. It is the most recent reconstruction of it, shaped each time by the emotional state at the moment of recall.
This is why two siblings can describe the same childhood incompatibly, and both be honest.
For someone in chronic pain the implication is uncomfortable and useful in equal measure. Pain is a distressing state. Memories retrieved while in it are re-stored with that colouring. The past does not simply sit behind you; it is quietly revised in the direction of how you feel now.
What this does not mean
Two clarifications, because this territory is easy to misuse and patients have been hurt by careless versions of it.
It does not mean the event did not happen. Reconstruction concerns interpretation and emotional weighting, not fact. Nobody is suggesting that what happened to you is negotiable.
It does not mean you should be grateful for it. The video uses the formulation that things happen for us rather than to us. As a private, patient-chosen stance that can be genuinely liberating — but it is not a clinical instruction, and it is not something anyone else gets to assign you. Some things are simply harm, and a person who cannot find a redemptive reading of their own trauma is not failing at recovery. If that framing helps you, use it. If it lands as an insult, discard it; the mechanism underneath works without it.
Where the past meets present pain
The clinically relevant part is the direction of causation, which is not the one most people assume.
The usual assumption: the past determines the present. The past was bad, therefore the present is bad, therefore the future will be bad.
What actually appears to happen: the present state governs how the past is read, and expectations of the future govern the present state. Someone who anticipates a life of worsening disability reconstructs their history as an unbroken series of injuries leading inevitably here. Someone with a credible expectation of improvement reconstructs the same history as difficult things survived.
Same events. Different reconstruction. And the reconstruction feeds directly back into the perception of current pain, because pain perception is not a readout of tissue damage — it is a brain-generated output that weighs threat, context and expectation alongside sensory input.
This is the same machinery we described in the neurobiology of a stuck alarm: an alarm system that has learned to fire on prediction rather than on evidence.
The medication trap
There is a specific loop worth naming, because it is common and it is quiet.
Substances that provoke dopamine release — including opioid analgesics — reliably reduce the distress of remembered trauma as well as the distress of physical pain. Used that way, medication becomes insulation from the past rather than treatment of the present.
The cost is that the same insulation blunts the forward-looking capacity the whole process depends on. Planning, imagining a different future, sustaining effort toward it — these require executive function, and they are precisely what heavy sedation and long-term high-dose opioid therapy erode. The patient becomes less able to do the one thing that would improve the reconstruction.
That is not an argument for leaving pain untreated — we have written at length about why that is its own harm in what untreated chronic pain does to the brain. It is an argument for treating the pain generator directly, so that the medication burden can come down and the cognitive room to reframe comes back. See opioid tapering: medication is a bridge, not a destination.
What this looks like as treatment
Reframing is not positive thinking and it is not a substitute for treating pain. It sits alongside interventional and metabolic work, and it is most effective once pain has come down enough that the patient has the bandwidth for it.
In practice it means examining what future you actually expect — most people have never articulated it — and then noticing how that expectation is colouring the account you give of your own history. Structured trauma-focused therapy does this properly; the recovery measures are covered in measuring recovery after trauma.
It also frequently requires something to do. Purposeful activity with other people does more for this than insight alone, which is the logic behind the work described in Valor Villages.
Frequently asked questions
Are you saying my pain is psychological?
No. Pain perception is generated by the brain weighing sensory input against threat, context and expectation — that is true of all pain, including pain with obvious tissue damage. Saying that expectation modulates pain is not saying the pain is imagined. See the neurobiology of a stuck alarm.
What if I cannot find anything positive in what happened to me?
Then do not. That framing is optional and personal, and no clinician should assign it. The underlying mechanism — that present state shapes how the past is read — works without requiring you to find a silver lining.
Does this mean I should come off my pain medication?
It means the goal is to need less of it, achieved by treating the pain source rather than by willpower. Never change a medication on your own. Do not start, stop, or change any medication without consulting your physician. See opioid tapering: medication is a bridge, not a destination.
Is memory reconsolidation established science?
The basic phenomenon is well described in the research literature. How much clinical leverage it provides in trauma treatment is an active area rather than a settled one, and we present it that way.
Where can I be evaluated?
Padda Institute, 4477 Woodson Rd, Suite 100, St. Louis, MO 63134, serving the St. Louis region across Missouri and Illinois. Call (314) 481-5000 or text (314) 886-5902.
Key takeaways
- Memory is reconstructive; retrieval makes it labile and re-storage is coloured by present state.
- Chronic pain is a distressing state, so it quietly biases how the past is reconstructed.
- Expectation of the future shapes the present, which shapes the reading of the past — not the reverse.
- The “it happened for me” framing is optional and patient-chosen, never assigned.
- Sedating medication insulates from the past and erodes the forward-planning capacity reframing needs.
Medically reviewed by Gurpreet Singh Padda, MD, MBA, MHP — Board Certified in Anesthesiology, Pain Medicine, Interventional Pain Management, Addiction Medicine, and Obesity Medicine. Last reviewed August 2026.
This article is educational and is not a substitute for evaluation, diagnosis, or treatment by a physician. Individual results vary. Do not start, stop, or change any medication without consulting your physician.
Find out what is actually driving your pain
Evaluation at the Padda Institute starts by identifying the pain generator and the metabolic terrain it is running on — not by adding another prescription.
Book an appointment or call (314) 481-5000 · text (314) 886-5902
Padda Institute Center for Interventional Pain Management, 4477 Woodson Rd, Suite 100, St. Louis, MO 63134 — serving the St. Louis region across Missouri and Illinois.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
