Pain is not a stimulus

Pain is not a stimulus, pain is not a stimulus, pain is not a stimulus ...

There are no pain receptors, there are no pain receptors, there are no pain receptors ...

There are no vias of transmission of pain, there are no vias of transmission of pain...

Pain is a response, pain is a response, pain is a response ...

Pain is build up in the brain, pain is build up in the brain ...

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Vision is not built in the eyes, smell in noses and taste in mouths. We smell, see, hear and taste the brain’s interpretation of reality.

We see what the brain selects as relevant in every time and place.

Perception is a brain action, not a passive process determined by senses and by what happens, but by the interpretation that the brain does of what has happened, happens and could happen.

The brain imagines reality and projects its assumptions on the screen of consciousness, a mysterious area for which we have no answers or well constructed questions.

Pain is a cerebral decision to project to the individual the probabilistic evaluation of threat that the brain considers at that time and place, trying to capture the attention and behavior of the individual for a defensive alert purpose.

If this probabilistic assessment is correct, the perception is physiological, functional, cost-effective. If it’s not, the perception confuses and bothers the individual with nothing in return.

I would be satisfied if I managed to eliminate from the readers’ reflections terms like "pain receptors", "vias of pain transmission”, “brain perceives pain" ... The brain does not perceive, it generates perceptions. Pain, as everything that is perceived, is an output, a response, that when it emerges, reenters in the network turned into an input from consciousness, from the individual, to the brain.

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Damage is a vague term that requires clarification. In my opinion, the details should refer to states and agents with necrotizing ability. Otherwise all sorts of pain are validated by any kind of tissue degeneration or inconvenience of personal scope.

Once again: pain is not a stimulus, pain is not a stimulus ....

Pain is in the brain ...

No brain, no pain ...

Sensors

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...

Rediscovering the brain

A fellow neurologist has written a review about my book "Migraine, a cerebral nightmare", in the Neurology magazine, an official publication of the Spanish Society of Neurology.

Rediscovering the brain. A. Digón.

I appreciate his interest and welcome. I must say that he is my friend and a member of my Neurology Department.

Avoiding necrosis

Nothing in Biology makes sense except in the light of Evolution is what geneticist Theodosius Dobzhansky once said, for it to be repeated and remembered whenever anyone had to meditate about what happens around living beings.

Pain is a biological process and we must seek its purpose and meaning in the light of Evolution.

Pain arises evolutionarily from the biological need to avoid necrosis.

Nothing makes sense in pain if not in the light (or darkness) of necrosis (consummated, imminent or just imagined, feared)

Surprisingly, in publications on pain we can hardly ever find a reference to necrosis, not even in the definition given by the IASP (International Association for the Study of Pain):

"An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage"

"...actual or potential tissue damage...". The type of damage is not specified. In my opinion, they should clarify it as "necrotic damage".

Cellular death is a part of life, it’s a physiological event which must be regulated, controlled, watched over. Cells must die according to the rules, by processes managed by the body. Necrosis is the death outside this biological law. A necrotic cell is a pathogen, a dead sack full of lethal chemistry, unleashed DNA. Necrosis should be detected as soon as it occurs. The potentially necrotizing agents and states should be identified and avoided.

Necrosis doesn’t produce pain, but necrotic chain death. The molecular signals that it generates, its identity signals, activate the neuronal sensors of necrotic damage and the electrical signals that bring the information of the incident to all the implicated systems emerge in order to defend the tissue integrity from necrotic danger. Pain is the final action of the alarm process: it’s the way the body communicates to the individual that there is some kind of trouble that must be taken care of.

If there is no consummated or imminent necrosis, pain should not be activated. If there is no necrotic danger, activating pain perception doesn’t make sense, a perception that emerged throughout the Evolution to alert the individual about the risk of violent cell death.

The fact that it doesn’t make sense doesn’t mean it doesn’t happen. The actions of living beings have no guaranteed rationality. In fact, the perception of pain, as other somatic perceptions of alert (hunger, thirst, cold, heat), is often activated without any circumstance of physical danger.

The body of the Homo sapiens (ma non troppo) has evolved with culture, a biological component of first order, and it’s no longer possible to understand its behavior, decisions, if not in the light of culture, as sapiens Culture is Biology, it’s Evolution.

We may have managed to minimize necrosis with culture, but the price is to maintain the pain function irrationally switched on.

Pain caused by imagined damage

- It hurts.

- Nothing is wrong in your body. Your brain must be imagining that there is some kind of danger. Pain is a real alarm, true, mortifying, but the threat is false. Until the brain’s fear disappears, pain will be wherever there is threat, wherever it hurts.

- So do you mean that this pain is imaginary?

- Not at all. Pain is pain. If you say that your nose hurts I have no reason to doubt that it does. Of course you could be lying: you could say "my nose hurts" knowing that it’s not true but that’s not usually the case. Imagination is a neuronal function. Imagining danger is a neuronal function. If this imaginative function transgresses the limit, the alarm goes off (pain, in this case)

- Why is it doing this right at this time and place even when nothing is going on? Sometimes it even wakes me up.

- Pain not explained by consummated or imminent necrosis has to do with danger on the inside of the body. The brain imagines danger on the inside. It doesn’t dream about falling or burning down the house or about a poisonous snake biting you, but about all kinds of internal dysfunctions.

- Okay, but where it hurts there must be something going on, there has to be some kind of change, for whatever reason.

- That is not true. That’s the biggest mistake. "Official" and "alternative" Medicines assume that wherever it hurts there must be something wrong, but it is not true. The body is represented in the brain. When pain is activated, the neuronal network that generates the perception in that area without any previous alteration needed is activated. The alarm goes off without a previous mock robbery. Imagining a flavour activates the same brain network that generates the same taste when eating. There is only a quantitative difference.

- So pain is in my mind? Is it psychological?

- It arises from neurons whether a state of imminent or consummated necrosis exists or the brain imagines a nonexistent threat. All three activate the same neuron network: the one that generates perception of pain. What distinguishes the pain is the presence or absence of danger.

- How complicated! Isn’t there anything to relieve this pain?

- Pain caused my consummated necrosis can both help the body to protect and repair the injury and trick the brain by blocking the information of the area. That’s what analgesics do. They sabotage information. It doesn’t have any consequences because we can control the repair process once the injury is detected. In the case of imagined damage, neutralizing the information that feeds the erroneous evaluation is essential. We may also use "remedies" to fool the brain but the effect does not last long. It makes the error worse.

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Pain caused by imagined damage is responsible for the drama of chronic pain or recurrent acute. Each professional creates a doctrine, a diagnostic label and some remedies. Only a few speak about the brain. Instead there is room for everything: food, weather, traffic, stresses, bad energy, contractures, hormones, mysteries ...

Hundreds of supposed triggers are guiltless. Hundreds of supposed remedies are offered and consumed. There’s a wide market and culture, but no science.

The purpose of this blog is knowledge: know pain, no pain.

Some people agree with the idea and others simply find it inadequate or useless, ridiculous, insane.

- Well, give me some of that knowledge, just to try it out.

Potential imminent necrosis

Angina pectoris.

- This pain on my chest makes me stop or slow down the pace.

- Your coronary arteries don’t let enough blood through in the heart muscle and pain is activated to prevent infarction (necrosis)

Intermittent claudication

- When walking about two hundred meters, my left calf starts hurting and I have to stop. Pain subsides and then I can walk another two hundred meters.

- Your femoral artery is obstructed, and there isn’t enough blood in the calf to do its job. Pain draws the limit and prevents the destruction of the muscle (necrosis).

Be careful with the soup, it’s too hot

- When I take a spoonful of soup I feel pain in the oral mucosa, which stops me from eating it.

- The temperature of the soup threatens the integrity of your oral mucosa and your esophagus. The pain prevents its destruction (necrosis).

Grounded with arms crossed

- Can I stop already? It hurts ...

- Get over it, this way you’ll learn a lesson.

In all of these situations, tissues are subject to a risky state of violent destruction if nothing is done to avoid it (not running, stopping to eat soup or bringing the arms down). Pain draws the limit of safety. Beyond this limit there is a risk of necrosis. If the dangerous situation is avoided, pain subsides.

The pain has the virtue of the protection of a threatened tissue. If necrosis has been consummated, pain protects its repair. If necrosis has not occurred but there is a risky condition, the pain ensures its avoidance, keeps danger away.

Southern Wind

- My head hurts when there’s Southern Wind

- ?

(To be continued...)

We will continue tomorrow with: Pain caused by imagined, probabilistic, wrong, irrational, cultural necrotic damage.

Pain and necrosis

- My chest hurts ...

- You’re having a heart attack.

The heart is a muscle that works tirelessly to give blood (chemical energy) to every cell of the organism. If it doesn’t get any blood (chemical energy) the heart muscle breaks down in a violent way. Necrosis happens. Neurons that keep an eye on necrosis detect their signals and send messages to the brain. The brain receives the necrotic message and, maybe, maybe not, it activates the chest pain program.

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- You’re having a heart attack.

- But it doesn’t hurt.

There is no equivalence between pain and necrosis. There is pain without necrosis and necrosis without pain. No signs of necrosis are enough or necessary to initiate the perception of pain.

In physical threat conditions with a fight-fly defensive response, pain may be absent. When running away from a lion who wants to eat us we can be harmed by scratches without feeling (or at least suffering) any pain. Stress is analgesic. Exercise is analgesic.

It was thought that painless heart attacks occurred mostly in diabetic patients who had damaged vigilant neurons. When no necrosis was found, the brain was not aware of the incident and the alarm of pain would not turn on.

That is what was once thought and defended ... until they found it was not true. One can have a heart attack, produce necrotic cellular signals, be collected by the corresponding vigilant neurons, those signals then be brought to the brain and, inexplicably, no alarms go off. Apparently nothing relevant happens in the chest ...

- Can’t you give me something to make it hurt when I have a heart attack?

- We have drugs to take away the pain but not to create it.

If relievers exist, then there should be "agitators" too. In the end, everything is chemistry. The organism has relievers and agitators and uses them according to its evaluations to calm and agitate the individual.

- Necrosis? So what? Keep running. Endorphins. No pain.

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- I know that there’s no necrosis but I'm afraid to move and mess it up... No endorphins. Cholecystokinin. Pain.

The brain has its reasons and applies them by removing or creating pain, by calming or agitating.

Homo sapiens (ma non troppo) tries to impose his or her own and offers all kinds of solutions.

- It hurts.

- Don’t worry. Here you go some sedatives.

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- It still hurts.

- It can’t be. We gave you morphine. You will have to go to the Psychologist’s office.

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- My chest hurts so badly. I'm dying...!

- Relax, we’ll take away the pain now.

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- Give him some saline. This guy has nothing. He’s a hypochondriac.

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- How are you feeling?

- It doesn’t hurt anymore. The calming effect worked.

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- I already told you he had nothing. He can go home.

A placebo can remove the pain of a heart attack. The placebo does not work as a test that distinguishes necrotic pain from the "psychological" one. Any therapeutic action (real or apparent) can cause the brain to turn off the pain (neurons ON) and activate the analgesia (neurons OFF).

The executive brain (prefrontal) evaluates and decides. Turns on and off. Calms and agitates.

- Necrosis? Now we’ll think it over and then decide.

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- I know that there is no necrosis... at the moment. But things can change. So I’ll activate some pain.

As said above: the brain has reasons unknown to the individual.

The individual has reasons that the brain often disregards.