The brain doesn't hurt

Once again, Descartes

Neurologists like to say that "the brain does not hurt". When the individual is awake, we importune him or her with all sorts of disturbing stimuli:

- Does it hurt?

- No

The brain has no “pain receptors". That explains why it doesn’t hurt. Any pain generated in the head necessarily has to come from the meninges and large blood vessels that do have the required receptors that detect the pain released by the tissues, when these are appropriately disturbed.

Generalizing this conclusion to other perceptions, we could also state that the brain does not smell, see, hear, taste, touch or feel heat or cold. The brain may be sad or happy, relaxed or anxious. We can stimulate specific places with electrodes.

- What do you feel?

- Deep sadness.

Tissues express their adversity through pain, but brain cells, depending on how the serotonin, dopamine, endorphins, adrenaline and other molecules go, do so setting moods and emotions free, that are detected by the corresponding receptors transforming them into signals that reach consciousness, where they are felt by the individual.

Does it hurt? Something is wrong about the tissues.

Are you feeling sad? Something is wrong about the neurons of sadness.

The statement that the brain does not hurt comes in handy for everyone. Everyone wants the brain to be limited to receiving Cartesian signals of pain and amplifying or ignoring them, whichever is more appropriate. We can manipulate those signals promoting the comfort of the tissues with diets, postures, exercises and adequate rests while we avoid the cerebral mood amplification modifying our personality and facing those that are inadequate.

We can manipulate pain signals with drugs that reduce and block them.    

When it comes to sadness and other neural disorders we can go deeper into the matter. We increase serotonin, opiates and cannabinoids, reduce the tone of dopamine and adrenaline and the brain will stop secreting discouragement, hearing voices and distress.

I like asking leading questions to the residents.

- How many eyes do we have?

- Two

- Well, there are two eye cameras that go around the world gathering data, but really there is only one eye, the eye of the mind. It’s in the brain. It is the one that really sees, or rather, builds what we see. It’s also the one that “takes looks”.

Eyes have no vision receptors, but receivers of electromagnetic radiation (light). In the retina, there are light and no-light receptors (darkness). Both are essential for the brain to see edges, contrasts, elementary and complex forms... The eyes do not see faces or trees. It is the brain that integrates visual memory (intelligence) and data from the retina and projects the result on our conscience, right when it crosses this mysterious area of perception.

It’s not nociceptors (receptors of nuisance) that build pain. They simply take data of consummate or imminent threat in the tissues. With these data and those provided by the memory of pain (nociceptive intelligence) the brain hurts ... projects pain at a time and place for a reason and for something...

The something-gen function, the one that causes pain, lives in the brain, like the "vision-gen", "smell-gen" and "sound-gen".

- Doctor, you’re repeating the same thing over and over again...

- I know, but the error of Descartes is well caught in the minds of the pain sufferers and their caregivers while the successes of the great René, his rationalism, the experimental method, the methodical doubt, distrust in what authorities say and senses ... are not part of our thinking and attitudes.

The brain may not hurt but it causes pain. The one that surely suffers from pain is the individual.

- It’s not your column that hurts. It is the brain.

- So it’s ME ...

- Not exactly. It’s your brain ...

- Yeah, ME ... The brain is ME!

- No. YOU are your brain and YOU. Both are important.

- They call it dualism ...

- Naturally, but there are many ways to understand ... A single cell is dualistic. Things happen inside of it (the intracellular) and the result of all this produces information that comes out (extracellular) and so the cell knows something about itself. There is an inside and an outside but they are integrated, interrelated. The brain would be the equivalent in body of what is inside the cells. The individual would be the outside ...

- Just leave it ... all I know is that it hurts

- All I know is that this indicates that your brain has decided to hurt ... here and now ...

The right to inflammate

At my office, I show an image of some firemen extinguishing a fire and ask the patient:

- Which one represents inflammation: the firemen or the fire?

The answer is, invariably: “the fire!”

Inflammation means lighting a fire, producing a flame. An inflamed tissue is hot and red, and sore and swollen. Firemen de-inflammate, they put out the fire. Hence, they are anti-inflammatories ... Elemental.

- Well, they aren’t. Firemen represent inflammation. Agents that aim to prevent the spread of the fire.

Words, when not adequate, play tricks. The term inflammation is absolutely inadequate, disruptive, pathological. It should be erased.

Inflammation is a defensive response that protects healthy tissues from something destructive and repairs the damaged.

 http://en.wikipedia.org/wiki/Inflammation

The idea that inflammation is a destructive fire that must be stopped with anti-inflammatories is widespread.

The compulsive and compelling application of ice exposes the error of considering inflammation something destructive that must be fought.

Certainly, the firemen cause damage in their fighting rage against flames, but no one thinks about calling the police during a fire to report some men that destroy doors and make a mess with water.

There may be a case of an excessive action of the firemen. They can destroy the living room to put out a fire on the corner of a curtain.

It can also happen that firefighters flood the house every time we turn on the fireplace.

There are some firemen that take excessive actions and kill flies with guns or that do not give permission to make good fires. There are excessive and unnecessary inflammations, but firefighters do not set things on fire, they put it out. They are inflammating agents ... "Inflammation", damn word! This way it’s impossible to understand it...!

Pain is part of the inflammatory status: tumor, redness, heat and pain...

Anti-symptom brigades try to avoid swelling, redness, heat and pain. They assume that firefighters are always excessive and unnecessary, even if there’s a fire.

The body needs this inflammatory response (firemen) quickly and decisively to put out any necrotizing, destructive fire and it also needs to measure its response. There is no inflammation without an anti-inflammation. Prescribing inflammatories and anti-inflammatories would make the same sense.

- You’ll have to take these inflammatories so it heals faster. Its temperature will rise, it will swell, it will hurt and it will look like a tomato.

There are some who argue that inflammation was necessary in the old days in the savanna when surviving carried being wounded day-to-day. In the comfortable life we have now, inflammation is excessive, inadequate, and must be contained, like high blood pressure. It can be, but first we have to take the measure of each one’s inflammation to see if it’s excessive.

- They said I have a high inflammation. I’m taking anti-inflammatories...

Tissues of the embryos don’t burn when they break. They regenerate. New cells are produced. With cellular development and maturation, tissues lose their regenerating power and resort to inflammation to repair themselves. It’s not the same, but the repairs are not completely bad: aesthetically poor and with their function somewhat diminished, but they still work.

Until proven otherwise, inflammation is timely and measured. It must be respected. If someone has a pathological inflammation response, the inflammatory rage must be controlled, allergy and hiperergy, using anti-inflammatories.

There is an obsession to discredit the self-management of the body. Everything it does is wrong. Everything is deregulated, it’s too much or falls short... Defensive, neural and immune systems are incompetent and need a professional’s correction that, at a glance or by simple hunch, feels that everything is swollen, wrongly swollen, excessively inflamed.

The sufferers feel swollen. They feel pain, so there is inflammation.

- There are sirens of firefighters, so there are firefighters. There are firefighters, so there is fire. Changes in weather should burn the house, because I can hear the siren...

- Are you saying that firefighters are inflammation, incendiaries?

- Yes, they are. Damn fire, blessed firefighters! Blessed inflammation despite that damn name!

The model of necessary and sufficient damage

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.

I confess I have suffered

I had been suffering from back pain for a while, but this didn’t prevent me from continuing with my regular activities. A bad day when playing football, I was sure I had suffered from a herniated disc. I rested in bed, but it was getting worse and I eventually was advised to undergo surgery. So I did. I was extracted a large extruded disc. It all went well... for about 5 years. Then everything went from bad to worse with prolonged periods of taking for sick leaves, immobilized in bed. It has been about 20 years since then.

Body movement was very limited by pain and stiffness. Getting in and out of the car, sitting down, turning around or putting my socks on each morning was difficult and painful.

And so on for several years, taking sick leaves one or two months a year, confined to bed. The scanner showed postoperative changes, fibrosis and degenerative changes. The neurosurgeon took for granted that my column would be unstable and spoke of "installing some metals” ...

It was then when I discovered that my enemy was the rest and that movement would get me out of that situation. It was clear that any attempt to do something would activate pain on the spine. I thought there was a “pinched” nerve root, contractured muscles, arthritis, fibrosis ... enough conditions to justify the pain. I still had Descartes in mind and assumed that pain arose from where I was feeling it, from the spine.

Through simple movements in various positions and getting rid of fear, convincing myself that nothing bad would happen, each day I started regaining more and more mobility in the joints. At the same time, I gathered information about pain, depression, anxiety, neurophysiology... One question led me to another. Necrosis, apoptosis, inflammation, tissue repair, evolution, perception, efferent copy, reward systems, hypervigilance, mirror neurons, pain memory, nociception, culture.

I inadvertently changed my whole mindset. I stopped being Cartesian. I discovered that pain wasn’t coming from the spine, but from my brain. Each movement was evaluated and programmed by the brain. I would only express my desire to get up and my brain would do the rest. If my desire to turn, bend or stand up was rated as threatening, a defensive-deterrent program was activated. If the brain didn’t see it as a threat, it could achieve the purpose with a suitable, articulated program without hesitation.

At first I needed some kind of ritual. I would sit on a kitchen chair in hyperlordosis and stretch my head toward the ceiling as if it would make some nerve unpinch. Within seconds I felt the lower back had relaxed. Other times it was not enough and I had to lie down and make a series of moves to free the lumbar joints, hips ... Occasionally limitations of the past reappeared to a lesser degree: cramps, lashes, stiffness... I had to take extreme care to avoid flexing the spine when lifting weights, sitting straight forcing the lumbar curvature (lordosis) ... Some days were better, others worse, but I never took a sick leave again. Over the years everything has dissolved. I feel the way I want to feel, I lift weights without thinking about how I should be doing it, I have forgotten the "good postures" and I make a normal life with no restrictions.

Ten years ago I began to shape all these changes in my beliefs and knowledge and then it was time for action with those who suffered from migraine. Until then I used to tell them what I had been taught to tell (genes and triggers), prescribed what I had been taught to prescribe (antidepressants, beta blockers ...). When the triptans and anticonvulsants came by I was already a convicted infidel. I had replaced drugs with by talks, therapy with education. Then fibromyalgia and chronic fatigue syndrome (myalgic encephalitis) came by. I read an article by Simon Wessely on cognitive therapy and found the transcendence of information, beliefs and expectations and the angry reactions of the sufferer communities.

Later came the theory of information, signals, noise, processing, Bayes, neuronal networks.

Just a bit before publishing my first book, Jaqueca, análisis neurobiológico de un dolor irracional in 2004 (Headache, a neurobiological analysis of an irrational pain) I read an article by a man named Lorimer Moseley and, later, when I was into neurobiopedagogy, I read his book  Explain Pain. Moseley’s book freed me from feeling the burden of a preacher in the desert alone, and recently, the appearance of the SEFID (Spanish Society of Physiotherapy and Pain) made me feel a member of a group of therapists (including my daughter and my son-in-law) with lots of shared convictions, absolutely passionate about the biology of pain, tissues and neurons.

I had a really bad time during the "spine years”. There was no horizon. Only pain, numbness, fear, despair, inability ... The “brain years” have released me from that hell.

And here I am now, trying to show new beliefs to sufferers, with varying luck.

- I'm not convinced ... You say that pain does not exist ... that's in my mind ... it hurts because I think it'll hurt ... that it's psychological ... but I have been detected several herniated discs, arthritis, osteoporosis, grips by Resonances, my physiotherapist told me that I have many contractions, stress... I go to a back training school ...

From what is brought up, it’s believed and from what is believed, it’s created. At least that’s the way it is for lots of spine pain cases.

Imagined damage

The body of Homo sapiens (ma non troppo) is managed by a socialized brain, trained in the culture to which it belongs. Many of its decisions will arise, inevitably, from what this culture dictates. Network programs are genetically disposed to be activated by both expectations and beliefs. If not, we would not be human. The development of the neocortex only finds its evolutive sense in our learning ability by representing reality imaginatively without suffering from it, ruminating what has been learned (in theory and practice) to extract knowledge and to avoid real damage in the theoretical, simulated tests.

It’s impossible to imagine something that has marked us as a species without having in mind the very human imagination function.

The ability to imagine does not guarantee us anything. It’s a laboratory where uncertainty is processed, the past and the present are reviewed in order to anticipate the future, ours and others’. In this laboratory of simulation of reality, everything is possible. The brain can give appearance to all kinds of events.

- It's like my head’s exploding ... as if my arteries were swollen... as if my eyes were being pulled out ...

The imaginative function is as real as breathing, digestion or kidney filtering but us sapiens (ma non troppo) don’t like to be reminded that what is perceived may come from the imagined.

- I’m not imagining anything, it just hurts.

Reluctance appears especially when assessing somatic issues. For God’s sake! pain perception can’t come from the imagined whatsoever. It necessarily has to come from a somatic physical disturbance or a psychological inconvenience.

Imagining is a neuronal function, namely, somatic. It’s not an ethereal, irrelevant function.

Tell me what you’re imagining and I'll tell you what you’re suffering from.

Imagining reality doesn’t create it magically. It only attributes it a possibility-probability.

Imagining that the plane will fall into the sea does not make it fall, but imagining the journey as a dangerous one will trigger the perception of danger, as if... we were falling into the sea.  

The neuronal network imagines at all levels in all its layers, from the most basic circuits to the most complex ones.

It’s easy to deduce whether something comes from imagination or not.

It hurts and you have nothing, so the pain comes from the brain’s imagination.

The alarm has gone off. There are no thieves, so the system has imagined a possible-probable theft.

Experts do not consider neuronal imagination as a source of suffering. Anything can be one: arteries, veins, diet, wind, stress, (female) hormones, electromagnetic radiation, sociopsiconeuroimmuneendocrineosteomioarticular decontrol. Everything is plausible ...

- So you are saying that it may hurt because the brain is imagining damage?

- Yes

- And... that’s it?

We should control imagination, avoid its ravings. But this requires experts to begin taking it seriously. Brains don’t imagine what they want, but what they can. They just ruminate what was presented as possible by the instructors.

I can’t imagine experts accepting the importance of the imaginative neuronal function all of a sudden.

- No wonder it hurts. Your spine is a mess.

- That’s what I thought... I wasn’t imagining things ...