– I think I understand. It makes sense. I think what you explained is true. But… what should I do?

A patient with migraine came to my office. Sitting next to me was a resident that was skeptical about the approach.

– How you doing?

– Okay. I haven’t had any more migraines. I don’t take meds. Sometimes I feel some pain but I control it.

– Explain to the doctor how you do it…

– I rationalize. I think quickly about what I’ve learned. I know that nothing is happening and I concentrate on what I’m doing.

We are instructed in the idea that something should necessarily be done to dissolve the pain. That something may be introducing a molecule with supposed powers to neutralize a supposed chemical responsible for pain: a needle, a herbal infusion, homeopathic products, meditation … Something added, aimed specifically at returning to normal.

In my office, I explain the basics of neurology of pain. Two objectives: dissolving errors and providing reliable knowledge. The perception of pain without justification has been activated. The brain has overestimated the probability of a destructive event. It’s not true that there is necessarily something wrong. The evaluative error is enough. False alarm. The apparent effectiveness of the reliever just indicates that the brain required the action of taking it and that this has dissolved the (wrong) assessment of threat. Nocebo to activate the alarm and placebo to deactivate it.

– Why does it hurt?

– Nocebo effect.

– How do I fight the nocebo?

– There are two ways: with placebo (doing something) or the conviction that nothing happens.

– I know that nothing is happening but even so… it hurts. At the end I have to take the painkiller. I need it.

Under experimental conditions we can get that when an inert cream is applied to the forearm before undergoing stimuli generators of pain (laser, heat …) the pain perception increases or decreases by changing one word of information:

– With the cream, you’ll feel less pain …

– With the cream, you’ll feel more pain …

It’s the same cream. A spoken word is a mechanical stimulus that generates a wave train that the ear captures … A change in the wave train is enough to increase or decrease pain. We can write information: moreless… In this case the word generates a subtly different light stimulus, sufficient to induce more or less of pain.

The pain therapies activate previously built expectations, by own experience, observing others’ experiences and instruction.

The observation of an analgesic action by placebo facilitates the placebo in our own flesh.

The duration of pain after the application of noxious stimuli varies if we trick the clock (one lap of the hands in 45 seconds.)

Knowing that a placebo was given doesn’t eliminate the analgesic action. The brain calls for action even knowing that such action doesn’t have anything relevant. Placebo. Deception.

The pedagogy of pain seeks to dissolve the false belief networks that feed the activation of false alarms. It seeks to dissolve the “nocebo-ness”, informative and cultural viruses. One of those viruses is the one that requires the therapeutic action, the cleansing ritual, the antidote to what (supposedly) makes it hurt.

The antidote for the nocebo is not placebo but the anti-nocebo, the anti-virus, not the virus of opposite sign.

– I understand, but I don’t know how to change my mindset…

– You’ll need to find out.

As Sol del Val said, everyone has their personal migraine and should explore it from the new interpretive frame provided by neurobiology.

Paradoxically, the patients with most migraines, most rebellious to treatment have a better response. They work in advance. They have tried all the therapies and are already disappointed. They need something new, different, contrary to what they so far have been provided.

Rationalization doesn’t have a good reputation. We forget the emotional part. There’s always someone …

An emotion is a state in which the organism assesses relevance, transcendence. Pain is the expression of the most powerful emotional state of the organism: the possibility of cell death, necrosis. Irrational fear is fought with rationality.

– I rationalize. I think about what I’ve learned. I continue with my homework.


>Control imagination




The brain receives information from the world (external and internal) through an extensive network of physical-chemical sensors. With the provided data, the ongoing interaction with reality and its impact (in our own flesh and others’) and what the wise and enlightened say about it, the brain builds a theory about the facts of the past, present and future and their relevance.

The available real-time information is partial, fragmentary, wrapped in considerable background noise. The brain has to fill gaps and solve uncertainties with imagination. It dreams, emulates reality, represents it on the blackboard of its circuits. With the individual turned off, with closed eyes and deactivated muscles, the cerebral dream has no moorings, no limits. When opening the eyes and reactivating movement, everything the brain imagined must abide by what the senses dictate.

The brain has books with missing chapters, chapters with missing pages, pages with missing paragraphs, paragraphs with missing words and words with missing letters, some of them somewhat confusing. That is the way it is and, with it, the brain has to draw conclusions about the possible-probable complete book that someone wrote. The remains can’t be deleted. The account must be respected. Controlled and constrained imagination by the demands of the sensory script.

The cerebral imaginative process is inevitable. It flows without a break. Imagining is a physiological neuronal activity as necessary as any other of the body (breathing, renal filtration, digestion…). Not always the imaginative process is connected, subjected to what the senses provide. If we are not focused intently on a task, the imaginative areas are activated and work once again reviewing one’s biography and others’, the future, the “what the others will say”. It’s the so-called “default mode” or daydreaming. It lets us act automatically while the mind wanders in virtual reality by the uncertain probability, by the turn to the past and the future.

Imagining the outside is relatively safe. Senses protect us from rantings. The interior is another matter. It’s a protected space in which everything must be controlled, regulated within narrow ranges of variation (homeostasis), but the brain is being bombarded by information on possible events and must be applied thoroughly to calculate probabilities of what it’s said to happen actually happening.

Cerebral imagination about the interior is no longer controlled, limited by the sensor data, but fed by the calculation of probabilities, by expectations. The brain rewrites books never written, not respecting the remains of letters, words, paragraphs and chapters but sayings, beliefs, myths, fallacies, theories … Processing is dedicated to segregate the believable from the unbelievable, with a strong bias to take the feared for granted. The theoretical possibility and the creeds impose their beliefs. Despite that everything inside will follow a sufficient, predictable and controllable course, the brain can be driven by fear and imagines all sorts of terrifying internal events.

The out-of-control cerebral imaginative process, self-fed, can go beyond the limits and cross the threshold of consciousness and appear as reality. A slight push of activity to the imaginative areas is enough to move from being a faint and brief shadow of reality to having perceptive substance, consciousness, appearance of reality.

– My head started aching.

When pain emerges into consciousness, the brain receives the information that it has done so. This gives credibility to the imagined. It hurts, then something (the feared) is happening.

Brain and individual get into a spiral of agreement on the fact that something is going on. The belief System continues to inject more strength to the neural connections that used to build the virtual world and have crossed the limit.

– The pain is increasing … It’s unbearable.

Something internal must be happening. Something harmful has crept inside. There’s nausea to eliminate it.

– I’m going to vomit.

The individual must be turned off but kept awake, alert, available, with the senses hypersensitive to any external stimulus. With no social interaction.

– I’m going to my room. Don’t talk to me, don’t turn on any lights… I have a migraine.

Control imagination. Be aware of its existence. Control the expectations and beliefs, the calculation of probabilities, its schooling.

Nothing is going on in the head. They are imaginations of the brain. That’s why it hurts so badly, with no limit.

>Congenital and acquired nervous system


We are born with circuits and programs that are already formed in the neural network. Certain stimuli will lead to reflex, predictable, forced responses. A harmless tactile stimulus applied near the lips generates the sucking action in the newborn. The little hand will close around the mother’s finger. An offensive stimulus will produce a strong retreat from the injured area.

The newborn has a congenital, programmed nervous system. The circuits that form it will always be active. They don’t disappear along with growth. They don’t evolve or change. Stimuli and responses are linked perpetually, immutably.

However, as the child’s development progresses, he/she stops responding in predictable ways. The same stimuli that used to produce always the same answers generates a different response in each individual. Stimuli that were irrelevant before become significant and what once seemed appetitive or aversive now evokes indifference.

Congenital, reflex responses have a neural architecture with a variable complexity of one or more layers of processing. The centers that integrate stimulus and response may be located in the spinal cord, the brain stem (joint area between spinal cord and brain), the deep brain or the corticothalamic circuit. There’s a hierarchical interaction between every level. It’s about circumstances, the event and its context. In general, the upper layers, the most complex ones, control the reflex, sensitive character of the lower layers’ responses. Control is, basically, inhibitory. Instincts are moderated.

The Nervous System contains circuits of closed, congenital architecture and an extensive network of outlined connections, taking care of tuning more precisely, analyzing the meanings of reality from a more complex perspective with more factors to consider and, above all, a distance in time and space. A stimulus or set of stimuli can mean many things. Nothing, something, a few, a lot. It depends on many circumstances. The significance of actions and events contains a lot of uncertainty. We must learn to separate the grain from the straw. To do this, we need to train not only the interpretation of sensory data every time, but especially memorize past and future relevances, the theoretical possibilities of variable probability.

The neural network’s open, alert, plastic architecture learns from the contact with reality. It continuously reorganizes its connectivity. It weaves and unweaves. It sensitizes and numbs. It removes and attributes relevances. It practises. It makes mistakes. It recognizes errors or gets stuck in them.

The brain is not intelligent by design. It’s a system that’s capable of learning, acquiring, evaluating. The “learnings” generate variable results. The course of our lives depends on them. The Acquired (learned) Nervous System can give meaning to our existence or make it an irrational hell.

Neuronal learning needs experience to collide with an appetitive and aversive reality, but also learns from observation of events in others and of what it’s said to be known about the occult. We have models and tutors.

Events, models and doctrines mark the course of learning. Depending on how our and others’ things go, depending on the moments and circumstances, depending on availability and attitudes of caregivers and the judgements and opinions from our tutors, the circuits with acquired connectivity will attribute relevance or deny what happened, happens, is going to happen or is believed to happen.

The connectivity of the Acquired Nervous System is culturized, embedded in beliefs, sayings, clichés, expectations, models. The responses are configured based on what the tutored learning process has generated. We are drawn according to predictable, known beliefs, those that the culture we are created in induce.

The Congenital Nervous System responds to the universal nocivity: extreme temperatures, mechanical energy over the tissue resistance, lethal metabolic conditions (lack of oxygen, acidity), germs … and it’s indifferent to any state or agent that doesn’t contain such universal harm.

The Acquired Nervous System complements the congenital ability to feel the consummated or imminent damage. It senses danger. It’s always paying attention to an extensive set of signals that providing the display of hidden danger.

The Congenital Nervous System is intelligent. It’s always right. It moves us further away from the real harm but doesn’t sense danger. It just feels it. The Acquired Nervous System is the one that deals with presentiments.

The symptoms: pain, fatigue, dizziness, itching, hunger, thirst, loneliness, sadness, discouragement, anxiety … arise, they are sometimes projected to conscience by the impulse of congenital connectivity, by an impact of the universal, by objectively intolerable states and agents that generate adversity or lack. Other times, they arise from the acquired, learnt connectivity, of the imaginative brain that has learned to sense the relevance from the uncertain viewpoint of beliefs and expectations. The symptoms are the same. Pain is pain, loneliness is loneliness, but the significance is different if the pulse comes from congenital connectivity, universal connectivity or acquired connectivity.

Wherever congenital sensitivity fails, the acquired pre-sensitivity can be right, and wherever this one senses threat it may have gone better for us with the indifference of congenital circuits.

It’s accepted that there is a Congenital Immune System and an acquired one. Surprisingly, the Acquired Nervous System is not considered.

Some inflammations are activated by the congenital immune system and others by the acquired one. There are default errors from the congenital and excess errors from the acquired.

There are pain and other somatic symptomatic perceptions projected to conscience by the impulse of congenital connectivity and there are also pain and other somatic perceptions projected to the same conscience with the same perceptive quality from the acquired, learned connectivity. There are default congenital errors and errors acquired by excess.

We find attenuators for the errors in the decision making of the acquired network in genes, in supposed neurotransmitter deficiencies, in reparative botched jobs of old tissue and heart wounds. The schooling process is not analyzed.

The Acquired Nervous System exists. It’s always there, learning and unlearning.

Learn to sense and feel it. Don’t let your guard down for the detection of errors.

Don’t rely on models or tutors. Demand rigor. Learn. Inject intelligence in the network. It doesn’t just fall from the sky.


>Beliefs and Knowledge


Louis Pasteur

Any kind of belief can orbit any issue or, rather, any kind of issue can orbit any belief.

I believe in medicines… for everything, in homeopathy for everything, in needles for everything … Everything can be referred to the creed embraced by oneself … at least for a while, the one that continues with the appearance of effectiveness:

– I only know that (right now) it works for me.

Beliefs about the body may be multicolored and evanescent, changing, capricious.

– Why don’t you try it?

Not everything (for everything) is always believable. Few citizens would accept being treated for bacterial meningitis or insulin-dependent diabetes with something other than antibiotics or insulin.

There are tangible diseases to which scientific knowledge has unveiled its dynamics, taken the initiative and overcome with therapy. There is little room left to believe whatever you like. It’s a matter of life or death.

One thing are tangible diseases and, another, suffering without a tangible disease substrate. A person with an objectively healthy body can suffer without limits. More than half the volume of health care is devoted to this area: chronic sufferers without a tangible medical certificate of disease. At most, a label (provisional) of supposed illness, a label that must be validated by the Diagnostic Labels Validation Office.

The lack of tangibility allows all sorts of speculations and proposals, both in Official and Alternative Medicine. In the intangible are the drugs, needles, herbs, homeopathic products, the “handicrafts” (chiropractic) … disputing the creeds of the sufferers.

Before Pasteur demonstrated the tangibility of infectious diseases, those who offered explanations of the intangible would dispute the origins and true remedies. The great clinicals of European Officiality held the theory of miasma: “putrid effluvia from decomposing organic matter”. They believed in miasma and ignored themselves as carriers of death in their hands, full of germs.

There are molecular explanations for intangibility (genes, neurotransmitters, toxins, food) or pseudo-molecular (molecule memory, faceless traces) and energetic (electromagnetism) or pseudo-energetic (ki, handicrafts, spirituality, mentalization, religiosity). Not in vain, everything is matter and energy (or pseudo-matter and pseudo-energy)… but there isn’t only matter and energy. We forget about history, evolution in time and space, the way matter and energy are intertwined, organized by evolution’s requirement. We forget about information, memory, prediction, probability, errors and their detection, learning …

We know a lot about matter and energy, enough to handle some problems of the body that have their origin and possible remedy in terms of matter and energy. What happens with information?

Neurons are physical, tangible entities, that generate tangible, detectable and quantifiable molecules and electrical signals. However, signals and molecules are at the information’s expense: they express memories and probabilities, certainties, uncertainties, anxieties, desires and fears … motivations, relevances, things not so tangible and quantifiable.

– It hurts

– You don’t have anything tangible. Which beliefs do you think can be responsible for this?

This comment is unthinkable at the doctor’s office. Perhaps the formula “what do you blame for it?” would be more fortunate …

– I believe that nerves, changes in the weather, wear, years, cervicals, nutrition, hormones, stress, that accident I had, separation have an influence.

– What treatments have you followed?

– I tried everything. Drugs, needles, homeopathy, herbs, diets … psychoanalysis … Nothing worked.

– You are in a Neurology office. We Neurologists are trained to solve issues with medicines… Do you believe in medicines?

– They haven’t worked on me. I don’t like them. They damage the stomach and don’t take away my pain.

Sufferers involuntarily confess their pilgrimage around the market of faiths. Belief in therapies go below the minimum, they are on the edge of absolute disbelief, despair or self-sacrificing conformity.

– Beliefs are your problem. You must get rid of them and fill the gap with what we know about what’s afflicting you. Forget about the solution. Listen, read, think it over and learn. Let the knowledge module your brain’s decisions. Its matter and energy are sufficient. You may need to review the information that manages them.

Information exists. It’s a fundamental component of matter and energy, trapped in the history of living beings. When a living thing dies it’s because it runs out of information. It’s only matter and energy pending to be part of another living space-time, informed.

There is information that cheers life up, that projects it to explore the environment. There is information that encourages inaction, catastrophism, disease conviction, claim of an official label of illness.

Take care of your information. You need it in order to live. Don’t devote yourself to obtaining pro-disease information. You will live in anguish.

– You have nothing. It’s just information. Your matter and energy are adequate but poorly managed. Believe me …



– Am I not going to get any treatment? Is it just like that, just talking…?

This comment may come up after an hour long explanation of neuronal origin of pain. It is assumed that instruction is not a valid treatment, approach or option.

It seems, for citizens and professionals, that there must be a coupled action that gives substance to the simple instructional discourse, the talk. Emotions should be worked on, seeing a person and not just a brain. Therapies, sessions, methods… I don’t know, something.

I don’t really understand the reluctance to validate the brain work, the reconstruction of the story that the brain is bit by bit writing on the body, the relevance of what has happened, its origin, its prognosis, what the future looks like.

– Only training, rescheduling, chip changing…? It will not be enough. We must do something else.

Important concepts such as the relevance of somatic (cerebral) fear to necrosis as a possibility, the addictive-phobic brain structure, organism’s psychopathology, error in decision-making, dysfunction of error detection, acculturation… are irrelevant, apparently.

The schema or body image, how the brain evaluates the state of the organism, its vulnerability, has a powerful influence on what the individual perceives as news of oneself or of one’s inside.

– Here. We will try to approach the story that your brain has been building of your body and of its interaction with your intentions and projects.

If I started explaining it that way, I would, in a few days, run out of patients. However, it should be the main goal, trying to put ourselves in the shoes of the brain as the scope of decisions that affect us.

– How am I?

– Your real body is fine, the virtual one is profoundly mistaken …

– ?

– I’ll explain it to you.

Many sufferers apply the tactics of St. Thomas: Believing is seeing. If pain goes away after acupuncture, I believe in acupuncture, even when after a while it stops working and I stop believing.

Beliefs are plastic, adaptable.

In brain issues we not only have to be like St. Thomas. The strategy of visual validation must be supplemented with belief, knowledge: Seeing is believing.

Sometimes, the band should be removed in order to see.