Consummated or inminent necrotic damage

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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.