The aim of this study was to investigate the relationship between (i) the pain and its side effects, anticipated by patients before orthodontic therapy, and (ii) the reported pain and its effects after the placement of initial archwires. Before treatment, 50 adolescent patients (median age 13.6 years, range 8.9-39.3 years, 28 female, 22 male) completed a questionnaire concerning their facial and dental appearance, and their expectations regarding pain, its influence on their daily lives, and changes in their facial and dental appearance as a result of orthodontic treatment. In the week following insertion of the initial archwires the patients completed a series of eight questionnaires, where they reported the level of pain experienced and its influence on their daily lives. In the week after archwire insertion, the maximum pain levels reported did not differ statistically from the anticipated pain levels. Patients significantly under-estimated the changes they would have to make in their diet as a response to pain after archwire insertion. Patients who anticipated a greater effect of pain on their leisure activities and those who had a history of frequent headaches reported higher levels of pain and more disruption of their daily lives as a result of pain. This pattern of response is consistent with a medical model where anxious patients and those with a history of chronic pain reported more pain after surgery.