An episode is something that starts at a time, place and circumstance, has a particular relevance and then ends. The brain organizes reality in episodes, events framed in time and space and that mean something.
In the organism, there is a complex process routine that is exquisitely controlled. From time to time something unexpected happens. That something may be an adverse event: an infection, a tear, lack of oxygen … There is cell death, necrosis. Alarms go off, defensive resources are mobilized. The area becomes inflamed, painful, hot, swollen, ruddy and out of order. Everything happens quickly. Every second counts. The deployment has mechanisms of positive feedback, of a haddock that bites its tail and grows. The priority is to end the state or agent responsible for necrosis. Necrotic cells are highly toxic and necrotizing. We must end them too. Once the necrotizing danger is controlled, repair comes. We must recover the damaged. It’s not always perfect, but the patches are effective and sufficient.
Pain protects the repair process. Once completed, pain becomes an obstacle. The tissues need activity to recover the normal condition and, in order to do that, the brain must remove the perception of pain, authorize and promote reuse, not penalize it. The danger has passed. Everything should go back to normal. End of the episode.
There are many necrotic episodes that trigger the acute phase reaction (inflammation) normally, but that leave the alarm on. The brain does not grant approval for the repair and continues penalizing the use. The pain is still there indefinitely in the form of a problem. The area is functionally seized with total disability. There isn’t any episode. There was a beginning but no end is granted.
– I have a herniated disc.
There was a time when the disc had been torn and the nucleus herniated, invading the space occupied by a nerve root. The alarms went off. It hurt, the joints were blocked, protector, alternative motor programs were activated,… but within days or weeks the site was reorganized, the necrotic remains were removed, the tear was mended and ready for the movement, necessary to restore function and architecture. Maybe the brain didn’t see it that way. It didn’t regain confidence and continues to deny the end of the episode, the license guarantees.
– Well, you had an episode of a herniated disc, but it is repaired, finished. You should move without fear. The recovery of the structure and function is not possible without movement. The acute-phase defense programs should be turned off. Your brain must know that losing a point joint between two vertebrae is not the end. Your brain should promote normality. Otherwise the lower back will become an absurd vicious circle.
– Yes, but it hurts, I’m locked, rigid, I can’t do anything.
– You are still in acute phase, as if your disc had just been ripped. It’s already cooled down, repaired. If you don’t go back to activity, purpose, confidence … you will never go back to normal.
The management of defensive processes by the immune and nervous system contains the danger of poor regulation. An acute episode becomes chronic, not necessarily because it left after-effects but because it hasn’t been considered as finished when it should.
Chronic pain is often a response of warn, triggered reasonably by an acute necrotic event that fear maintains unreasonably active. There is no physical vulnerability, but simply fear to going back to normal. The brain does not trust the repairs. It doesn’t event know they exist.
– You haven’t driven the car again.
– I have an accident
– Yes, but that was a few years ago and you brought it to the garage to have it repaired.
Citizens continue to use the present to tell about the real past and the imagined, feared future.