Outbreaks of pain

In the presence of a manifest harmful event (consummated or imminent necrosis), the pain arises from the brain as a result of the arrival of a damage signal flow that was generated in the afflicted area. Nociceptors (vigilant neurons of damage) transform (transduce) the molecular messages of the attacked cells and the responsible stimulus (mechanical, thermal, chemical, biological) into electrical potentials that activate the group of brain areas that generate the perception of pain.

– My right index finger hurts. I’ve accidentally hit it with a hammer. See how it looks. It’s swollen … I can’t even touch it…

In this case, the perception of pain has a clear origin, an event that generates a noxious stimuli enough for the brain to project the painful perception on that area.

The problem comes when we feel pain in the absence of a noxious event or state capable of stimulating nociceptors. Pain receptors of damage need a stimulation of sufficient intensity. A heat nociceptor only generates a signal above 45ºC. There are also other heat receptors that are activated under 45ºC and we feel painless heat but, if we pass that limit, we feel pain. The nociceptors of dangerous heat have been activated and the nociceptors of harmless heat have been turned off.

An area hurts. There are no extreme temperatures. No dangerous mechanical, chemical or biological stimulus turns on any nociceptor. Nothing relevant is happening there… but the perception of pain has sprung from the brain. Project, there and now.

What makes this perception of the painful brain areas emerge?

The answer is simple. A threat assessment has been produced in the predictive memory systems. The brain expects possible damage. There and now. Why? We don’t know. The brain represents reality as a probability without expecting it to actually happen.

The pain can be reached both by noxious events and their “pre-diction”. No confirmation of the feared is needed. The pain is not only a result of the consummated or imminent harm. It’s also the result of the theoretical evaluative states of the “pre-feelings”.

The outbreak of pain forces the individual to pay attention and evaluate the painful area, consider what may be happening and what it may be due to (trigger).

The outbreak may happen after eating chocolate or changing weather conditions.

– My head hurts. I shouldn’t have eaten chocolate.

Really the chocolate hasn’t activated a population of nociceptors. The painful brain areas have been turned on by the action: eating chocolate, a forbidden food for being classified as potentially harmful.

The evaluative brain judges states, events, actions, omissions … to which it attributes a capacity of threat. The pain arises when it reaches the theoretical, speculative danger level in the representation of the body. Nothing happens or is going to happen, but the theoretical attribution is enough to bring out the painful perception. Aggression, consummated or imminent nocivity is not necessary. There is no flow of nociceptive signal.

Since the moment the individual receives the perceptive projection of pain, he is involved in its development. He will have to make decisions, consider possible causes and remedies.

– It hurts. Why? What I can do to make it stop?

Culture has instructed us in the external solution:

– Take a painkiller. Don’t wait.

Even if nothing happens, the brain, the organ of the virtual, of the imagined, requires what it believes should be done. If in its circuits it’s said that he should take the painkiller, the pain will remain until the individual meets the requirements.

– I didn’t want to take anything but, in the end, I had to …

Pain requires behaviors, actions. That’s the function of any perception, proposing actions, selecting aspects of reality, filtering, amplifying …

Outbreaks depend on the neuronal network’s dynamics. They don’t adjust to the logic of tangible causes and effects.
In pain outbreaks caused by evaluative and probabilistic dynamics, irrationality, error, phobic and superstitious fear and addiction to relieving behaviors are the ones that rule.

Any irrational action can neutralize the irrational fear. The brain’s instruction to demand it is enough. The nocebo and placebo relay on irrelevant conditions. They turn the harmless into potentially destructive, and the unnecessary into a necessary and sufficient remedy.

The probabilistic cerebral ravings are corrected by pruning the weights of the neuronal connectivity that attribute danger to the non-dangerous. We must project rationality, knowledge, bringing virtuality to reality

– Don’t buy lottery tickets. You won’t win.

– And what if that number is the winner? The need to buy it has sprung.

Virtual battles must be fought in the virtual field, but we don’t always win. It’s a matter of time, perseverance and determination.

– The pain has sprung. The brain hallucinates. It imagines pain … What a cross to bear!!

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>Me, myself and I

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– I don’t want it to hurt.


It’s a precision that I often hear in my office. My attempts to explain the biology of pain, the cerebral imaginative process, fail in many cases. The “I” of the moment has felt alluded and has misinterpreted the speech. The victim has felt pointed out as guilty.


– It’s not you. It’s your brain.


– My brain is ME.


– Yeah, right.


If it hurts it means that the brain assesses threat. It’s a system of neurons from which states of connectivity emerge, groups of synapses (contact points between neurons) that sizzle at the same time, generating different perceptions. Pain is one of them. The brain “decides” it hurts. It wants it to hurt. It wants it because it considers that the individual should put aside his or her issues and focus on the danger that at that time, as predicted by the memories, is in a body area.


– I don’t understand why MY brain would want ME to suffer.


– YOUR brain has been selected throughout evolution to, among other things, ensure the safety of the organism. It does that by creating hypotheses of danger, uncertainty, risk, probability. It’s like your bodyguard. Don’t ask it for rationality. Fear isn’t always rational. Brains are fearful, depending on how fearful or daring the individual living in that body is.


– I need a solution, something to take away the pain. Last week I had to go to the emergency room to have someone give me meds.


– We must do something about your brain. Calm its absurd fears. The pain intensity is telling you to what extent the brain is scared. If you must go to the emergency room it’s because your brain requires it to calm down.


In security issues, we can easily access the unconscious, without hypnosis, divans or deep meditations. Somatic perception shows meanings of neuronal processing. Hungry? the brain wants you to eat … Itchy? your brain wants you to scratch yourself… Pain? your brain wants you to stay still and take YOUR reliever …


The function of pain is not to delve once again into the wounds of the individual, as interpreted by the defenders of somatization or the psychosomatic. If the head hurts it’s because there is cerebral, somatic fear to something physical, terrible, happening at that time in the head. If it hurts after a heartbreak it means that the brain considers the heartbreak a threat to the physical integrity of the head. Neither food nor hormonal changes, or the hassles at work or sentimental failures contain the immediate risk of causing a brain hemorrhage or meningeal infection.


– Yes. I DON’T think so.


– Yes … but your brain is acting “as if” all those triggers contained that threat.


The situation is similar to the one of the Immune System, the other alarmist system that sees danger everywhere … until proven otherwise. The vigilant immune cells carry in their membrane protein receptors-detectors. Each cell clone is dedicated to detecting one of them. It fixes it on the membrane, digests it and presents suspect areas that should be assessed in the network. Sometimes that protein is the cat’s, pollen’s or house dust mites’. If the immune “brain” believes that this protein belongs to a hazardous agent, it will decide to release the production of the clone to defend the body from an imaginary, absurd danger. Neither the cat, nor pollen or mites release germs, but for the body, for the immune system, there is danger of infection.


The “I” doesn’t have problems accepting the responsibility of YOUR immune system in an allergic reaction, but the same doesn’t happen with YOUR brain. It doesn’t let other people talk badly about it. It feels alluded.


– It can’t be MY brain. I’M not like that…


Yesterday I saw a patient that had come three years ago because of migraine. After the first visit, she decided not to come back. She went around taking painkillers, needles, homeopathy, herbs, diet, yoga and others until she ended up in the emergency room and had to come back to the Neurology office.


– I don’t want it to hurt me. What I need is a solution.


I think she finally realized that she hadn’t understood the first time she came. I’ll tell you how it goes…


The SELF is tough. The brain is a tricky construction. Otherwise the brain could not make the individual do whatever it wants:


For example, going to the emergency room for some meds …

Primary and secondary pain

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The “classifiers” distinguish between primary and secondary pain. The latter arise as a result of damage in the place where we feel pain, and the firsts appear without us detecting anything relevant where it hurts.


There are primary headaches (migraine, tension headache …) and secondary (tumor, hemorrhage, bump …).


Primary pain is supposed to have origins, even when they aren’t tangible. Migraine, they say, arises from some genes that build hypersensitive cerebral generators of migraines. Tension headaches are generated by states of anxiety, nerves that contract muscles excessively. Primary pain is actually secondary. The pain comes from something. That’s what the patients always say.


It’s not clear whether the “spine” pain is primary or not, without a tangible cause. If something hurts, it’s taken for granted that one’s lower back or neck isn’t well. Mechanics, loads, physical effort, postures, wear, years are what matter. The “bone pain”, depending on the point of view, is primary or secondary.


– My bones ache …


The statement stands for itself. It could be a primary pain derived from the condition of the bones, which is hurting themselves.


– The bones don’t hurt …


If one wants to lose the confidence of the patient, all he/she has to do is that staggering claim. However, it is so. Bones don’t hurt. The pain may arise from harmful events of the bones, events that generate neuronal signals that reach the brain areas able to project the perception of pain in the conscious display of the individual. The “bone pain” would, therefore, always be secondary.


– When the weather changes, my bones can feel it.


Time is to the bones the same as nerves are to the head. The primary headache would be secondary to the overwhelm, and the primary bones would be secondary to the cold and damp.


Something similar happens with discouragement. Depression can be primary, without an apparent reason, or secondary to a depressing event. Psychiatrists prefer to call the primary endogenous and the secondary exogenous.


I’ve never understood the difference between endogenous-exogenous or primary-secondary. What is perceived is always the result of a complex cerebral evaluation process. There is always a decision of the network.


– I have a primary pain for no reason. They say it’s the brain, which has its reasons to turn it on, but I don’t know them. The MRI is normal. There really is no reason. The brain is wrong.


– Exactly. The primary pain is a secondary pain to an erroneous cerebral evaluation.


There are primary and secondary people. A primary person is someone we can see without there being a person. If we take a picture of where we see them, they don’t appear in the picture. A secondary person is the one we see for the simple reason that he or she is really there. He/she is in the picture.


– A hallucination?


– Yes.


There is primary pain in the absence of states and agents that activate the nociceptor network. We are sorry, but on the area of the disease there is nothing relevant, harmful.


– A hallucination?


– Technically it is a hallucination, but don’t go around saying that…


Pain without harm, hunger without malnutrition, cold without low temperature, loneliness in a crowd … are primary. The necessary and sufficient objective condition to be explained and understood is not given.


I don’t like the classification of primary-secondary, endogenous-exogenous. I prefer to distinguish between perceptions-right productive choices, and wrong-unproductive.


There is pain, discouragement, cold, hunger, dizziness; unnecessary, disabling, sterile, pure pathological tiredness. They are secondary to an erroneous assessment of relevance-probability, that is … primary, as “classifiers” claim.


There is pain, discouragement, cold, heat, hunger, tiredness … that are necessary, convenient to guide the behaviour of the individual in the right direction. Secondary, exogenous, justified …


The content of what is perceived does not guarantee its objectivity. There may not always be people where we see them. People may not always be where we see them. The MRI may always be normal wherever we feel pain.


– There is a threatening man in the living room.


– Let’s see … There’s no one. He’s a primary man…


– What do I do? What do I tell him to go away?


– Don’t pay attention to something that doesn’t exist. If you do so, you’re lost.


Checking account balances are sometimes negative. Classifiers distinguish between the primary negative, which appears without one finding the reason for it, and others that arise after a lavish expenditure.


Negative checking accounts express the balance between what goes in and out over time. The usual expenditure is enough for the alarm to go off, without us getting any benefit from it.


The brain manages our account. It doesn’t need to run out of money. If it considers that we shouldn’t spend it, it blocks our account without further explanation.


– I’ve been feeling discouraged lately. I don’t get it, everything is right …


– Everything hurts, always, and they can’t find anything.


The primary is that way… Homo sapiens (ma non troppo) is perhaps a more primary species than we think …

>Hyperalgesia

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– I have a high rate of pain. Everything hurts, always.


Pain is a perception that should emerge only in situations of damage that require protective behavior of tissue integrity. We should only open our umbrella when it’s raining. Always carrying an open umbrella just in case it starts raining is not a good idea.


– I always have high blood pressure.


Hypertension is only justified when we are in a situation that requires a blood flow rate that ensures the blood supply to tissues to cope with certain situations. Giraffes have high blood pressure. Otherwise, blood would not reach their head.


Sustained hypertension ends up damaging the arteries. It’s important to control it with drugs and healthy lifestyles.


Now they say that continued, chronic pain, ends up damaging the brain and, the same way it happens with blood pressure, it should be controlled with drugs and healthy lifestyles.


There is a problem with that proposal: the chronic use of analgesics is a major cause of mortality. An analgesic is an addictive toxic.


– Control your pain. Don’t take too many analgesics. Ask your doctor.


– I have already asked. She tells me to always take the medicine early.


The pain is considered (erroneously) as something that arises from tissues and that when it reaches the brain it generates disrupted, neuronal stress that ends up shrinking the cortex.


– I’m hungry. Always. I would eat anything.


– Eat something. Don’t wait. Hunger ends up creating health problems.


Food is effective in controlling short-term hunger, but it prepares more future hunger. What affects health is not always feeling hungry but always eating, obeying the brain’s requirement.


– Give me something so I’m not hungry. I don’t want to be eating all day. I’m gaining weight. Food has side effects.


The role of hunger is to encourage the individual to seek and swallow food. The role of pain is to encourage us to stay still.


– It hurts.


– Don’t move.


– I need to move. Give me something for it to stop hurting so I can move.


Other times, the brain uses pain to avoid the individual standing still.


– I can’t lay still in bed. I need to move my legs or get up and walk.


– Get up.


– I need to be in bed in order to sleep. Give me something for it to stop hurting so I can stay still.


– You have the “restless legs syndrome”.


The restless legs syndrome is one of many syndromes of cerebral anxiety and restlessness. Nothing is wrong with the legs. There are no problems of circulation or any other kind. It’s the brain that expresses its concern at the scene of nightly rest and prefers, God knows why, the individual to stay awake, exploring the world, alert.


– I’m sad and I don’t know why.


– Do something interesting and enjoyable.


– I don’t feel like it. Give me something so I feel like it.


The brain is dangerous for the individual. It’s not always right in its assessments. The ancestral fear of harm and failure makes it protect us too much, for no reason. It forces us to always carry an open umbrella for the fear that something will wet us or that we will stay, unwilling, at home.


We must know that there is a pathology of cerebral decisions, the policy of preventive excess. The individual must know that the management of the organism’s programs is in the hands of a system that can make serious strategy errors.


– I’m worried about my brain. I’m bored of its alarmism and its catastrophist predictions.


– Don’t mind it. Trust the real situation of your tissues. Don’t open your umbrella. It’s a lovely day. There isn’t a single cloud. The forecast for this entire week is of good weather.


– Can’t you give me something for the catastrophic brain?


– Common sense. Confidence. Rationality. Knowledge.


– Not for me. I was referring to some kind of therapy …


Cerebral catastrophism and pessimism generate a system of neural activity that, if maintained in a chronic way, can cause cortical thinning and tonsil fattening. Boredom turns off hippocampal neurogenesis. Neurons need a nice atmosphere, good vibes.


Sometimes all we need is to wise up…


– Give me something for the “wising-up” … With all the advances we have today, isn’t there anything for this…?


– No.

>Control imagination

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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.