Migraine, fibromyalgia, are diseases whose origin and cure are unknown. That’s what they say.
Why it hurts so much and so often really is a mystery if what the doctors say is true: that there is nothing abnormal in the time, space and circumstance of pain.
– It shouldn’t hurt you.
It’s the same with pain and other perceptions.
– I’m hungry every day and every hour.
– You shouldn’t be hungry. You are well-nourished. Over-nourished, I would say…
It’s the mystery of why some citizens’ hunger increases when they eat, rather than diminish it.
– I’m more and more hungry. I don’t understand it. No food fixes it…
The brain is a perception manager. It projects hunger, pain, heat, cold, dizziness, fatigue, boredom, euphoria … for reasons that we don’t always understand. If we have been several days without food it’s understandable that the brain reminds us, with hunger, that the body needs energy, but it doesn’t make sense for the brain to project the urge to eat on us if we are a little overweight.
The disease of chronic, unwarranted hunger is a mystery. The researchers track the chemistry of hunger in search of molecules that turn the need into a compulsive addiction. They always find one and make the media bells sound.
Those molecules are also found in that kind of pain.
The researchers are optimistic.
– In recent years there has been considerable progress in the understanding of pain. In the future we’ll have new drugs. Controlling the suffering won’t be a problem.
The problem of the future is that it’s never present in this issue.
The issue of hunger is not improving. Every day thousands of people die because of chronic insatiable hunger. The problem may even be getting worse.
The pain also wreaks havoc. Every day thousands of citizens die by chronic, insatiable consumption of analgesics. The problem may even go from bad to worse.
Reasonable, economic management of perceptual resources is not guaranteed. The brain doesn’t have a smart natural condition. Rather the opposite. It’s the individual’s job to channel the brain’s biological dynamics, selected for harsh and competitive environments, and adapt them to the universe of “everything is a hundred yards tall” and be safe.
There are children hunger and chronic pain, insatiable.
Some believe that everything is because of the inconsistency between what the alarmist genetics claims and what the culture of abundance offers. The human molecules of pain and hunger are the same as those of flies and worms in the laboratory. We should to track the differences between cultures.
Curious and erroneous idea of culture. It seems that there can’t be cultural impregnation until we access the “use of reason”.
The sapiens brain (ma non troppo) is, by what genetics dictate, candid, imitating and “schoolable”. It absorbs culture since the first hours of life.
Parents, teachers and friends are always around the child projecting words and examples, said and dones. The child’s brain is a pasive schoolchild that takes everything that happens and hears in order to process it according to rules we don’t know about.
This week a patient came to my office with migraine, neck pain, rather chubby, moderately discouraged and she was a smoker. She did a good job of schooling in “my brain and it’s “I”” … She no longer has migraines, her neck doesn’t hurt (there was also a great pedagogical work of two excellent “neurophysic therapists”) she has earned a few anti-kilos, she is courageous after quitting the antidepressants she no longer absurdly inhales addictive toxic smoke..
She is an ideal patient, intelligent and hardworking.
– 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: more… less… 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.