Survival Instinct

The human being has an original condition that gives meaning to every living creature: survival.

All the complexity of the organism finds its meaning and purpose in keeping alive all the efficient and reliable cellular individuals that it hosts on its space-time. Any detected sign of cellular incompetence or selfishness (cancer) activates a programmed death (apoptosis and others). No uncertainty permitted.

The organism is the result of a labored evolutionary intercellular social contract, reflected in the complex processes of genetic expression.

Until proven otherwise, everything can be unacceptable, punishable. Any cell could not be able to do its job and become a burden, a handicapped ... or be too clever and do as it pleases reproducing without measure, without paying attention to what the regeneration and tissue repair requires.

The body doesn’t fool around. The cellular quality control operates without blinking an eye on any minimal molecular signal of disability or ambition.

There is something the body fears in particular: the violent death of its cells (necrosis). First, because its avoidance is what led to the appearance of cellular societies. It’s the part of the contract that must be met: avoiding death by lethal agents and states, of its own and of others, internal and external. Secondly, because a necrotic cellular individual is a pathogen, a sack of corrosive chemistry and unpredictable DNA. The body detects necrosis with sensors located in the membrane of immune and neuronal vigilant cells and proceeds to deliver the inflammatory response, a complex process of removal of necrotic remains and regeneration and repair of necrotic tissues.

The body smells the consummated necrosis in alien flesh (through necrotic pheromones) and enhances it via all kinds of sensory signals (smells, tastes, colors, shapes, sounds...).

Homo sapiens (ma non troppo) has, apart from the conservation instincts (sensory signals of real time potential danger), language, culture, with its own instinct: the instinct of conversation.

The language has led to the excessive madness of knowing and spreading it all through any process: imagination, illumination, anointment...

The lawlessness to know everything at low prices, with no effort, has generated a cognitive atmosphere (infosphere, noosphere) of brain intimidation, of fear of the known-unknown, of the possible-improbable.

Organisms react to danger in two ways: either running away or remaining motionless. Pain, discouragement, lack of energy, negative rumination, contracture are various forms of expression of a frightened, catastrophic brain.

The instinct of conservation and the natural talkative-apostolic sapiens, the instinct of conversation-conversion are generating new sufferings of all kinds.

It’s all about emergency, a mysterious property that generates emerging diseases ...

Inside

We can divide the world in two enclosures: the outside of the skin and the inside of the skin (exterior and interior).

The classical senses in eyes, ears, nose, tongue and skin extract real time information of the external universe through light, mechanical, thermal and chemical sensors. The sensory data are processed in various layers of the neuronal network leading to the mysterious spectacle of perception, the process that gives meaning to the external matter-energy.

The outside-of-skin world is made of trees, birds, houses, people, clouds, cars, carrots, flames, spines, storms... The brain sorts the matter-energy in objects with meaning, endowed with relevance, which is variable depending on its context. It picks out the shape of the important on the background of the irrelevant and, with its filter, proposes  behaviour-interaction patterns (appetitive or aversive) with all the highlighted objects.

Cells live in the inside-of-skin world, individuals endowed with a membrane that divides the internal world in an outside-membrane and an inside-membrane world (extracellular and intracellular).

The outside-membrane world is analyzed in real time by all kinds of membrane sensors. There are no equivalents of the classic senses (eyes, ears...). We don’t see, hear, taste, touch or smell the bowels. For the individual the inside is opaque, sensorially unknown. It’s a black box. For the cells of the outside-membrane world it’s a universe so vibrant and meaningful as the individual’s outside-of-skin world. It’s full of objects endowed with meaning, relevance and emotional valence.

The Homo sapiens (ma non troppo) detests black boxes. It needs to fill it with objects and processes endowed with relevance and affection from its evaluative point of view.

The inside-of-skin world becomes an universe with lungs, hearts, stomachs, circulations, digestions, defenses, bones, muscles, nerves, joints, irons, cholesterols, elusive viruses, diseases, arthritis, migraines, strokes...

The individual can only imagine (wish-fear) events and internal states, their possibilities-probabilities.

The speculative brain of the sapiens (m.n.t.) shows on the conscious screen of the individual the result of its data process on the possible-probable state of the inside-of-skin world.

Usually this projection is a speculative theoretical purr, asymptomatic.

Sometimes the brain’s speculative-predictive process of internal states-events overflows the threshold of the purely theoretical to become an emotional state that fears that the theory could become real at that time-place.

The speculative theoretical purr becomes symptomatic, acquires a perceptive body as pain, dizziness, fatigue, hunger, thirst, cold, heat, anxiety, discouragement, indolence...

The brain projects for the individual his speculations on the black box of the inaccessible.

- It hurts...

- There is nothing wrong inside you. Everything’s normal...

The doctors apply their sensors (stethoscopes, analysis, radiographies, fluoroscopies ...) on the inside-of-skin world, on the black box. They feel, look, hear, smell and taste it with artificial sensors and don’t find any relevant objects-states or, what is worse, they find irrelevant states and give relevance to them...

The outside-of-skin and inside-of-skin worlds are full of pre and post-feelings, uncertain potentialities. The senses, natural and artificial, do not detect the past or the future, they are not activated by what was speculated.

Symptoms appear when the brain gives importance to the outside-of-skin and inside-of-skin objects-states.

Once the detectable pathological objects-states are discarded disease states it’s clear: the sufferer suffers the consecuences of a sensitized brain, trapped in the alarmist speculation of the theoretical possibility turned into imminent: what might happen is about to happen...

- There’s nothing wrong inside you. Alarmism should be lowered in the neuronal network. No one could live with a brain like that... The house is secure. We should convince security guards to let you live in it.

... And there was pain

The sufferer is not very rigorous when accepting a convincing explanation for the origin of pain. Any explanation is fine, provisionally, if the remedy works for them.

- You have a contraction, so I’ll give you a massage.

- It’s swollen, take this anti-inflammatory pill.

Sometimes, giving a remedy to the supposed origin is not easy.

- You have a pinched nerve. Osteoarthritis. You, genetically, have migraines.

There are no rejuvenating, “eugenising” drugs.

Surgery helps pharmacopoeia soldering joints, peeling nerves, installing prostheses... Genetic engineering, they say, is just around the corner too.

Other less aggressive proposals offer food. Those inadequate are responsible for the pain and the adequate keep the pain away.

We are left with energy disturbances, mysterious toxins and a long list of disorders of all kinds that find their normalization with all sorts of therapies.

The ONs and OFFs of pain have their own rules.

As so often noted in this blog, pain is an unpleasant, alarming perception, that reports the existence of consummated necrotic damage, either imminent or imagined by the brain.

Applying this biological requirement, it’s clear that almost all the above accused as generators of consummated or imminent necrotic damage are left out. Attributing violent destruction capacity like a sunburn, an infection, laceration, lack of oxygen, acids ... to diet, stress, hormonal changes or changes in the weather... is not easy.

In the "bio-mechanical" or "muscle-skeletal" pain section it’s easy to blame the bones, joints and muscles because of their friction, degeneration, aging, corrections, curvatures, overloads, contractures, grips, mysterious diseases, swellings,... There is a wide range of mechanisms for the healers’ and sufferers’ like... Once believed, muscle-skeletal explanations are difficult to solve. None of them can resist a rigorous neurobiological analysis ... but no problem. There are no neurobiology inspectors of pain that ensure the credibility of what is being said...

Pain can appear every time the brain imagines that something could generate necrotic damage.

Imagination is a basic biological function. It is not easy to survive without imagining lurking dangers.

The Immune System imagines violent destruction and sees danger in air with dust mites and pollen and activates inflammation on the border. It also imagines the danger of uncontrolled reproduction (cancer) on honest cells that do their job and tells them to get out of the way (apoptosis).

Imagining damage is a biological first-order constant. Highly complex living beings have optimized their imaginative function to catalog all kinds of states and suspicious agents.

The first suspicious agents are the individuals. Their actions. What they do or eat, how they feel, the way they sleep, whether they have problems or not,... Their past, present and future are suspicious and are being constantly analyzed by the brain.

Imagined necrotic damage is the flagship of our body. It is generally responsible for the pain whose credible source has not been found.

- Maybe my brain imagines necrotic damage

I can not picture myself hearing that at my office. However, it has a biological substance. It should convince the patient.

- What can we do for the brain to reason, to cease to be alarmed for no reason and let me live in peace?

Sounds good. The answer is not easy but being aware of the problem is the first step, a necessary step ... though it’s not always enough ...

Consummated or inminent necrotic damage

*********************

I know I repeat myself with this matter but, from time to time, it’s good to remember the important thing, the root.

A key issue in the field of pain is to differentiate it from harm. Tissues do not hurt, they do not segregate pain but can be damaged, altering their physical integrity.

There are many types of damage. The fundamental is the violent, sudden, sharp, accidental damage. It is produced by states that are, at short-term, incompatible with life: extreme temperatures, lack of oxygen, compressions, tearings, bacteria, acids. The affected cells die in a dangerous way: the membrane breaks and the chemistry from the inside escapes, which is highly destructive and generates violent death of the healthy cells around them.

This violent death is called necrosis and it has to be detected and neutralized immediately in order to prevent the organism’s death. Vigilant cells from the immune and nervous system detect necrosis signals (and the agents capable of generating it) and quickly proceed to take care of the problem.

Pain and inflammation appeared throughout evolution as the nervous and immune systems’ responses to necrotic threat. Pain is a complex perception that comes from the combined activation of several brain areas. Inflammation is a complex cellular response of protection and repair of tissues.

Activation of pain and inflammation should be exceptional, it should only occur on episodes of  accomplished or imminent necrosis, when something is torn, crushed, burned, frozen, does not receive oxygen or is colonized by a germ. Out of the context of violent injury, pain and inflammation generate an unjustified burden to the individual and its organism. It’s an irrational, alarmist, phobic investment. Somatic fear to necrosis is at the bottom of those unnecessary switch-ons.

Tissues can lose functional quality because of physical-chemical stress, degradation, degeneration, aging, deformation. They generate a less efficient work but they are not a necrotic threat. Therefore inflammation or pain should not be activated.

Cerebral projection of the perception of pain on an area where there is no necrotic threat is frequent. In these cases there is a danger to explain-justify the painful switch-on by any “abnormal” tissue pain (arthritis, osteoporosis, disc protrusion, contractures ...) found in the painful area.

- I have arthritis

Arthritis does not explain-justify on its own the switch-on of pain. There are innumerable articles whose title contains this question: why does arthritis hurt? The answer is not clear but it’s been suggested that the vigilant, nociceptive (consummated or imminent necrotic damage detectors) neurons’ contribution can be fundamental. If they are alert, sensitized, hypervigilant... any mechanical stimulation can generate a danger signal and induce the cerebral switch-on of pain on the area.

The problem is explaining the hypervigilant-hypersensitive local state. Some (peripheralists) think that this condition of alert is caused by tissue degradation, by accumulated mechanical stress throughout life. Others (centralists) think that this hypervigilant state comes from a primary alarmist brain evaluation. Somatic fear to necrotic damage increases the vigilant neurons’ awareness. And synthesis. Both factors can have influence.

In any case, it seems rational to protect vulnerable areas from mechanical stress and unjustified alarmism.

What is important for the sufferer is to be protected from pain, ergo, analgesia. It is understandable, but ...

Pain has a protective function. If we remove it, we leave the joint exposed to all kinds of mechanical dangers.

It is difficult to propose (and convince) the patients of brain issues of pain projected on an arthritic area. Mechanics are mechanics and, at first glance, seem to explain the pain but ... there is always a brain that evaluates and tends to fall into alarmist excesses.

I don’t think the brain should be left on its own, imagining necrotic danger in every nook only for being somewhat degraded, degenerated or aged.

- It’s normal that it hurts. It’s been used for a long time.

Don’t be so sure.

Neurobiopedagogy

Two and two is not always four. Four is one of the many possible hypothesis.

On Manual Therapy 15 (2010) 382-87, Cormac G. Ryan’s group from Glasgow Caledoniam University published a study that should make an impact, although I’m afraid that it will remain unnoticed.

I usually don’t make entries about articles but I think the occasion deserves it.

The authors studied the effectiveness of teaching about the biology of pain and exercise in low back pain-sufferers.

One group was only given education, words. A course of two and half hours on basic concepts of neurons, fear of movement, pain does not mean damage, live a normal life... following Butler’s and Moseley’s guidelines.

Another group is given, in addition to words, an aerobic exercise program for the spinal muscles.

Previously, there were some studies that showed the effectiveness of pedagogy on the biology of pain (Moseley), the inefficiency of pedagogy isolated on the biomedical, structural model, and effectiveness of aerobic exercise.

Since exercise and pedagogy on the biology of pain are beneficial, then joining those two virtues, verb and action, knowledge and exercise, optimal results should be obtained.

A + B, A and B beneficial, should be higher than A + 0 (no B).

Nope.

A (education on biology of pain) + 0 (no exercise) has better results than A + B (exercise)

Adding exercise removes some of the benefits produced by pedagogy.

Conclusions:

Just attending one simple class (blah, blah, blah) the student learns basic neurobiology of pain and its sufferer condition gets better significantly: "know pain, no pain"

Knowing that pain is different from damage and getting rid of the fear of movement is necessary and sometimes sufficient to feel relief.

There’s nothing like continuing with the usual activity.

If, after attending these biology of pain lessons, the student attends workout sessions, something changes and he or she goes back to his or her sufferer state. It could be that the exercises reactivate prior expectations of "muscle-skeletal" pain.

Muscle-skeletal pedagogy is ineffective if it does not fit the ritual of exercise.

Muscle-skeletal exercises trim the effectiveness of neurobiological pedagogy.

If we tell the sufferer: ‘your spine is a mess’ and we don’t do anything about it afterwards, it sure gets worse.

If we tell the student that his or her spine is reasonably apt for the struggle, and that what pain indicates is that the brain fears action and not the way the spine is, the situation gets better as long as no one else (more or less intentionally) suggests once again that the spine column needs help (financial).

- So, it’s all about talking? No exercise or anything?

- That's right. Don’t be afraid to move to achieve your goals. Forget about your spine. No exercise routines to strengthen... forget about the concept that your body cannot hold weight...

We do not need more muscle, but more knowledge... learn to unlearn...