>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 …

>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.

>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.

>What were you told in the emergency room?

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– You have a neck contracture. Use this collar for two weeks.

We know that a high percentage of citizens who have suffered a cervical whiplash in a collision will later develop chronic pain, fibromyalgia and/or PTSD.

Experts have tried to find the keys to turn an acute episode (mechanical trauma) into a chronic problem.

The problem affects women more, there is coexistence of psychological factors, fear of pain, lack of control, catastrophizing… and correlation with the severity of mechanical impact can’t be seen.

Experts do not include in their search something that, for me, is important:

– What did they say or do to you in the emergency room?

So imagine you’re standing at a traffic light and receive a subsequent impact of another car that decided to skip it.

The ambulance comes. Someone places the collar. Neck x-rays…

– You have a contracture. A cervical sprain. You must wear this collar. Be careful when moving your neck. Take this anti-inflammatory and muscle relaxers. You might feel a little dizzy…

Well, you might be alarmist, have had stress in your childhood, sexual abuse etc. All of these have an influence, but it’s also about the professional. There are two types:

Type I: alarmist, interventionist, ominous, hypervigilant, hipertherapist…

Type II: calm, reasonable, weighted, alarmed by alarmism…

Type I makes takes x-rays, puts collars and gives muscle relaxants but gets the opposite of what was wanted: alerting the nociceptive system of a sensitive sufferer.

Type II disarms the alarm with arguments and encourages citizens to resume normal life while warning them of the ominous.

Experts do not include in their studies if the sufferer has been treated by a Type I or Type II professional.

– What did they tell you in the emergency room…?

Invariably, my patients were put a collar and were told they had a contracture. The Type I put fear in their necks.

Probably, I only see patients that were attended by Type I professionals. Those attended by  Type II professionals go home without a collar and fearless and are less likely to suffer from pain later in their lives.

So, if you go to the emergency room with a “cervical whiplash”, you risk having type I or II.

>Sensors

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The environment contains all kinds of states, agents and events. Living beings obtain information about them through sensors, sensitive proteins capable of undergoing a change in contact with a particular physicochemical variation.



The receptors of the retina are sensitive to changes in the light reflected on objects; the ear ones, to the mechanical waves generated by interactions of objects; the smell and taste ones, to molecules with information about various elements of the environment, appetitive and/or adverse …



There are light receptors, mechanical receptors, thermal receptors, chemical receptors… and there are also necrotic damage (consummated or imminent) receptors.



The body is packed with sensors-receptors of consummated necrosis, located in the membrane of specific neurons and immune system cells, vigilant, capable of detecting violent cell death (necrosis).



Receptors of the retina (photoreceptors) detect light, photons, and the vigilant neurons of necrosis (nociceptors) detect signs of necrosis. If there is no light, there is no activation of photoreceptors. If there is no necrosis, there will be no activation of necrosis sensors (truism).



The necrotic cell loses membrane integrity and internal chemicals are released. Necrosis receptors pick them up and the reaction ‘molecules-death—necrosis sensor’ generates an electrical signal that contains information about the deadly incident, an electrical signal that is carried by the neuron to various assessment and defensive response centers.



In threat of imminent but not consummated necrosis, neurons and immune vigilant cells detect dangerous agents and states: extreme temperatures, germs, mechanical stimuli, lack of oxygen, acids… Membrane sensors react to such agents and states and report the hazard and the need to respond to the threat. Signals of necrosis danger are produced, but not signals of consummated necrosis.



In imagined, probabilistic, speculated necrosis, no nociceptors are activated for the same reason as in the dark no photoreceptors are activated or in the silence no ear receivers are activated.



In the absence of sensory activation (light, sound waves, aromatic molecules, extreme hot and cold, stretches, mechanical compressions, insufficient oxygen quantities, pH…) the brain can activate the areas responsible for visual, sound, touch, scent, taste perception, and generate a mild and fading perceptual version. We can imagine tastes, smells, sounds, images, pain, hunger…



Usually the absence of sensory signal contains the imaginative function, it reduces it to something very subtle and inconsistent.



When we sleep, sensory inputs are disconnected. The imaginative brain processes past and future sensory data, real and fantastic, constructs impossible narratives, free ones. The brain dreams, plays with the real and the unreal. The perception becomes realistic, hallucinatory. It doesn’t need any senses. They are an obstacle.



Reality can be experienced or imagined. Senses hold the imagination but don’t always succeed at doing it.



The IASP says (International Association for the Study of Pain) that pain is an unpleasant sensory and emotional experience. I disagree. Current sensory experience is not needed. Consummated or imminent necrotic damage sensors can be mute.



“… Vision is a sensory experience …”. Not always. Sometimes we see things that are not there. There is no activation of photoreceptors, but apparently what we see is real.



– Does this mean that my brain has hallucinations, delusions of mind?



– It creates hallucinatory states of imminent necrotic damage, but not mental delusion or madness. It’s just wrong. It rates some non-existent threats as true. It doesn’t wait until necrosis occurs. It tries to prevent danger. Turn on the pain…