End of the cycle

“And then straightaway
he put on his hat, brandished his sword,
sand with a sidelong glance, stole off.”
My professional cycle has been closed. Today is my last day. I am retiring.
I’ll continue writing on the blog and participating in the proposed initiatives to spread knowledge about neurons and body perception.
I leave the corporate world (Osakidetza) after several years of preaching in the desert of my hospital with the most absolute disdain of what I could contribute with my proposals.
The brain, neurons, have something of a taboo for professionals and, to a lesser extent, for the sufferers.
The disdain to what is ignored is striking and unbearable. Few let the auto-complacent calmness of the politically correct doctrines and agreed protocols get disturbed. Migraine, it’s argued, is a genetic brain disease. Period. They only hope to identify the responsible genes to provide the specific antidote for each individual, upon presentation of the genomical card. Everything that isn’t a molecular contribution is pure quackery. A waste of time.
Knowledge about neural processes should have imposed a radical change in concepts and proposals for neurologists. There are no signs of that happening. Basic issues such as perception, emotion, cognition, mobility, placebo, empathy, mirror neurons, efferent copy, reward system, decision making, error detection, nociception, information processing, Bayesian logic… are exotic matter for those who feel comfortably installed (with the timely support of Farmaindustria) in the universe of new drugs.
The texts are still contaminated by a symptomatic lexicon. They keep talking about pain receptors, pain signals, pathways of pain, pain centers. They still maintain that the brain does not hurt if you puncture it and, as the only painful intracranial structures are in the meninges and their large vessels, that’s where you have to find the source of pain, in the “trigemino-vascular axis.” The reality is that the painful brain area was never actually punctured, for the simple reason that it is hidden deep in the “sylvian valley”, in the lobe of the insula. If you puncture it when the guy is awake, he confirms it hurts. The brain does hurt … if the sensitive points are found.
Pain is about anti-inflammatories, triptans, antidepressants and anticonvulsants, electromagnetic stimulations, electrodes, botulinum toxins, detachments of tight muscles … and information, a lot of information. We must make the citizen and the professional be aware of it. Workshops, conferences, campaigns, international days for pain … but no word is said about the risk of information.
“I swear to God, I’m astonished by this grandeur…”
Last week I was invited to a High School to speak about neurons and pain. Everything was new for the students. Their minds were as open for Neuroscience as for homeopathy or acupuncture. Their brains were already colonized by the alarmist culture of the “pain because of everything” and the “cure for everything”. I tried to warn them about indoctrination, acculturation, imitation of what is offered as sacred without further argument than the identity of belonging. Science against market and culture. Freedom from the critic, explorer, rigorous knowledge.
The brain is very interesting and sells audience in the media but we must move the media away from our bodies. It’s a mental thing, not a body thing. Health is not a game. No speeches. Solutions, solutions …
“And then straightaway
he put on his hat, brandished his sword,
sand with a sidelong glance, stole off.”

The mystery of the mysterious diseases

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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.

– Culture, you say? Children have no culture, but they have migraine and fibromyalgia. It’s the genes and the undisclosed mysterious thing. There are entire families affected by this.

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.

For her there is no more mystery. It’s all simple.

>Rationalize

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– 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.

>The model of necessary and sufficient damage

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Even knowing that it’s not necessary nor sufficient to have tissue damage in an area for the brain to project pain on it, many experts are determined to seek such damages as necessary conditions and, once they claim having found them, they sustain that pain has been sufficiently explained.

The necessary and sufficient condition of damage is applied in every body region. One of them is the head.

Damage can be searched and considered as welcome in any component: skin, fascia, nerves, nerve-muscle junction (end-plate), bone, sutures, meninges and blood vessels. Beyond those, there are only neurons which we know don’t hurt because they have no “pain receptors”.

One way to locate the necessary damage, spinal pain, is to palpate and pressure.

– There, there…!

It hurts there. The reason is there, the germ of painfulness, the property that turns normal tissues into painful ones.

Muscle is a good place to find painful outbreaks. A sustained contraction would be sufficient to explain why it hurts. It is therefore necessary to find it or take it for granted.

You have a neck contracture.

– You apply too much pressure on your teeth at night.

– You frown excessively.

– You strain your eyes too much.

Neurologists distinguish between migraine, a neuronal disease (genetic hyperexcitability) and tensional headache, a condition in which pain settles in the scalp muscles, excessively contractured.

The origin of muscle contractures is not clear, but it is assumed it’s stress, another condition that comes in handy to explain everything.

For non-neurologists, migraine may also come from tight muscles or dysfunctional joints. Cervical and temporomandibular joints are good places to find necessary and sufficient damage.

Correlations between joint damage-dysfunction and pain are not clear. There are opinions for all tastes and needs but it seems that the image is not enough to certify the pain or that the pain is not enough to anticipate the image.

Muscle pain can be found by pressing. After locating the painful spots (“it hurts there”), the necessary and sufficient condition, the field of solutions opens with punctures, injections, manipulations, detachments, prostheses,…

When investigating the painful condition of the tissues it’s found it that goes beyond the area where the problem is supposed to be. The body is sensitized to stimuli even where the patient doesn’t find pain.

Migraine, tensional headache, “temporomandibular disorders”, “cervical”, Fibromyalgia … tend to go together and express themselves in the same sufferer.

“… all signs point to a central sensitization …”

The neural network is being sensitive. Okay, but … Why?

The model of necessary and sufficient damage claims that there necessarily must have been a state of injury-dysfunction in the tissues at first (joints and muscles) and that this is sufficient to explain the subsequent state of sensitization.

Fear, sensitization to theft must necessarily come from a previous consummated self-theft.

– Since they broke in I can’t live in peace… I’m sensitive.

Fear to thefts is not accepted as a sufficiently sensitizing condition without having suffered from it in their own property. The theft of others, information on thieves … they don’t seem to be enough to generate alert, sensitization…

– It hurts

– You have central sensitization in several areas

– What is that?

– Fear of injury… fear of pain.

– I AM NOT one of those that …

– It’s not you. It’s your brain. It’s sensitized.

There is reluctance to accept that you can get to central sensitization without the initial push of injury.

It’s not accepted that the probabilistic brain sensitization is sufficient, speculative on damage to explain pain nor is it thought to be necessary to amplify a chronic pain fed by a smooth flow of nociceptive signals.

– My brain, culture, information, my narrative…? So, is that all? It seems insufficient to me. There necessarily has to be something that hurts.

Descartes… immortal Descartes.

>Fears and phobias

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Fear is an emotional state that expresses an evaluation of danger. Something is experienced as threatening and we must try to avoid or cope with it with prevention.

There are rational, justified fears. They make us be aware that there is a real, possible danger. Fire, cliffs, snakes, traffic accidents, thieves, unemployment, loneliness, social rejection, germs, toxins, disease, pain … are real states and agents that have the negative condition that justifies fear.

When the theoretical possibility of threat is associated with a negligible probability of the dreaded actually happening, fear becomes a phobia. The aircraft can fall into the void, the bee can sting us, we can make a fool of ourselves if we open our mouth, we can get stuck in the elevator, food can be poisoned … but well, probably that won’t happen.

Our empathic, socialized condition is our downfall. We tend to represent other people’s events as our own. We are supportive. We feel envy and compassion.

– Don’t be afraid, flying is safe.

– Yesterday there was a plane crash. All passengers died.

There are also irrational fears, extreme phobias. They are constructed by attributing danger to states and agents that are always irrelevant.

– My astral chart…

– I ate chocolate. My head is in danger.

– I’ve used the computer too much, my head is going to explode…

The brain doesn’t have an aversion to irrationality. We only have to look at ourselves, register our behaviors.

Homo sapiens (ma non troppo) is governed by a brain that manages reality from virtuality. It attributes the environment all sorts of possibilities. It’s no longer just getting carried away by the possible even when it is improbable (phobias). It also gets carried away by the impossible.

– You’ve been using the computer for two hours already. Your head will explode.

The cerebral irrational fear to computers is expressed to the individual through pain. The individual has a rational, logical fear to suffering, to having a migraine. The brain expresses somatic irrational fear with realism. It seems that the head is about to explode, really, given the violence of pain. But nothing is happening.

– I’m afraid that my head will hurt.

The justified, rational fear to pain moves (excites) the individual to seek causes and cures. Antidotes and spells.  

The brain requires the individual to take consistent actions with its irrational fear. It can detain the individual in a dark room, motionless, nauseous, intolerant to stimuli. It forces the individual to find and apply the antidote, something that danger conjures, the reliever, whatever that leaves the sufferer alone.

– The sedative started to take effect and now it doesn’t hurt as much.

The individual attributes the virtue of the soothing relief to painkillers. He or she believes that there is a chemical that puts in order some molecular disorder but, really, what the remedy dissolves is cerebral fear. It is the ritual, the action, what the brain requires. If the individual meets the requirements, the brain releases the poor sufferer.

– The danger is gone now. ‘Back to normal’ authorized.

Once the crisis is over, the brain revises everything closely. It looks for associations wherever culture shows responsibilities. Many times it can’t find any and tightens the nuts of pain even more. It becomes more frequent, intense, persistent and refractory to painkillers.

Homo sapiens (ma non troppo) as well as being empathetic and imitative is also educated, indoctrinated. The Homo sapiens (ma non troppo) builds irrational fears instilled by irrational cultures.

Homo sapiens (ma non troppo) is touched by the tendency to obey what he or she believes even if it is irrational.

A brain with migraine is sissy, empathic, imitative, obedient, politically correct.

The sufferer must be aware of this and object, rebel… disobey.