In absence of damage...

Pain is a perception projected by the brain that contains an evaluation of necrotic damage (consummated, imminent or imagined) and that encourages the individual to have a defensive behaviour of avoidance-reparation of such damage.

- You don’t have anything, it’s just your brain.

Starting the discussion of the brain’s responsibility in pain generation requires a previous discard of the existence of a necrotic damage incidence. Pain always comes from the brain, with or without damage. The discussion on the Neurobiology of Pain is always correct, but the state that "you have nothing" must be correct too.

One can explain in detail the mechanisms of an alarm system, the possibility of going off without it being triggered by a thief, but it must be quite sure that it is that way. Sometimes thieves don’t show their faces.

- It's a false alarm ... The security system contains a probabilistic module that assesses the potential probability of theft before the thief goes in. It balances all information about thefts and when it fears there might be one, it goes off.

The information is correct but we can make mistakes when diagnosing "no theft".

When I began to face the issue of pain with Pedagogy I made mistakes like "you have nothing, it’s your brain".

There are two types of errors.

1 - There is an abnormal condition that fully justifies pain. For example, a brain tumor with intracranial hypertension ...

2 - There is an abnormal condition that doesn’t justify the generation of pain. For example, an extensive cerebral arteriovenous malformation with no bleeding.

In both cases an MRI will make us lose our sleep for a few days if we have already placed the discourse of the brain without having discarded previously any abnormality.

In the first type of error we are wrong in every way. There is a thief that the security system has detected. The alarm has gone off because the necrotic damage sensors are activated by increased intracranial pressure.

In the second type of error the statement "you have nothing" is not correct, because, really, there is a vascular malformation, but pain does not appear because of its presence. At that moment, there isn’t any circumstance of necrotic threat. No bleeding or increased pressure. The sensors have not been activated, but the MRI detects a time bomb that nobody knows when will explode. It’s not the brain that detected the problem, but the MRI.

The errors of both types made me increase, in all cases, caution and include in the speech the possibility of both errors. Surely caution, fear to fail, generates an excess of tests, but I think they are unavoidable.

There is a third type of error. The "error", with quotation marks.

- He said I had nothing. I went to another doctor who gave me an MRI and found several "herniated discs", "column deviation"...

In this case there is no time bomb. The discourse of the brain is fully justified and must be supported and implemented while trying to dissolve the expectations and beliefs that the "diagnosis" of hernias and deviations generate.

Diagnosis is difficult, risky. All the precautions are not enough. Errors are always there. They must be minimized. The temptation of doing defensive Medicine and ordering all proofs to everyone is always there.

Acting upstream, outside the usual frameworks, is difficult, risky.

To not make the mistake "of the brain", denying the brain is not ethical, turning away, taking refuge in the politically correct ways.

- I spent years taking pills, spending money on physiotherapists, psychologists, neurologists, pain clinics ... Nobody talked or thought about these things you’re telling me.

It also happens, and when it does, it's great for the ex-sufferer and for the professional.