Muscular consistency

Contracture, overload, spasm, hypertension, hardness, knots, myofascial points, increased consistency ...

- My neck hurts

The physical therapist feels the area in which pain is perceived and concludes:

- Your neck is stiff.

If there is a confusing issue in the field of pain it’s the aching muscle. The so-called "muscle-skeletal pain" is a damn jumble, a conceptual disaster.

The muscle is a tissue of varying consistency to palpation and the joints also show a varying opposition to pasive movement. By feeling and moving, the physical therapists draw conclusions about the muscular condition, their responsibility in the genesis of pain.

Muscular consistency is influenced by many variables. A muscle of increased consistency can be too tight, or not. If it’s tightened, it can be due to neuronal stimuli or specific conditions of the muscle fibers.

Contracture is not synonymous with contraction. Increased consistency is not synonymous with contraction. A muscle that is painful with palpation doesn’t have to be contracted. Pain is not something that makes the painful muscle contract. It is a false cliché.

The static muscle aquires more consistency and higher viscosity, but moving it actively or pasively is enough for its consistency to decrease. It’s a strange property of the so-called non-Newtonian fluids, the thixotropy. A "hard" muscle becomes "soft" simply because it’s thixotropic. The same happens with ketchup, paints, honey ...

Muscles can be unnecessarily contracted (as lights could be unnecessarily turned on when there is no one in the room) and express their discomfort or vulnerability through pain. Relaxing them is enough for consistency and pain to yield.

There may be bad postural, psychological, programming conditions, overexertion... There may be myofascial trigger points that fatten the vicious circle of pain (always with the collaboration of a vigilant and catastrophic brain). There may also be a brain that defends an area from individual’s purposes.

After the pain and increased consistency of muscles from one area, there are many variables: muscular, neuromuscular, cerebral ... There are contractures, contractions, viscoelasticity, protections, alerts, bait points ...

The physical therapist palpates, moves, questions, values ​​... informs, back to palpating, moves, shows, convinces...

The universe of static and kinetic muscle is complex. It’s not my universe. I’m a neurologist. The physical therapists have a great job to do: to clarify that universe for themselves and for citizens.

- It hurts ...

- Let's see, calmly... This is very complex.

PD Elefante, a worthy reader of the blog, recommended me this post:

http://bretcontreras.com/2011/03/a-revolution-in-the-understanding-of-pain-and-treatment-of-chronic-pain/

Don’t miss it!

End of the cycle

"And then straightaway

he put on his hat, brandished his sword,

sand with a sidelong glance, stole off."

My professional cycle has been closed. Today is my last day. I am retiring.

I’ll continue writing on the blog and participating in the proposed initiatives to spread knowledge about neurons and body perception.

I leave the corporate world (Osakidetza) after several years of preaching in the desert of my hospital with the most absolute disdain of what I could contribute with my proposals.

The brain, neurons, have something of a taboo for professionals and, to a lesser extent, for the sufferers.

The disdain to what is ignored is striking and unbearable. Few let the auto-complacent calmness of the politically correct doctrines and agreed protocols get disturbed. Migraine, it’s argued, is a genetic brain disease. Period. They only hope to identify the responsible genes to provide the specific antidote for each individual, upon presentation of the genomical card. Everything that isn’t a molecular contribution is pure quackery. A waste of time.

Knowledge about neural processes should have imposed a radical change in concepts and proposals for neurologists. There are no signs of that happening. Basic issues such as perception, emotion, cognition, mobility, placebo, empathy, mirror neurons, efferent copy, reward system, decision making, error detection, nociception, information processing, Bayesian logic... are exotic matter for those who feel comfortably installed (with the timely support of Farmaindustria) in the universe of new drugs.

The texts are still contaminated by a symptomatic lexicon. They keep talking about pain receptors, pain signals, pathways of pain, pain centers. They still maintain that the brain does not hurt if you puncture it and, as the only painful intracranial structures are in the meninges and their large vessels, that’s where you have to find the source of pain, in the "trigemino-vascular axis." The reality is that the painful brain area was never actually punctured, for the simple reason that it is hidden deep in the "sylvian valley", in the lobe of the insula. If you puncture it when the guy is awake, he confirms it hurts. The brain does hurt ... if the sensitive points are found.

Pain is about anti-inflammatories, triptans, antidepressants and anticonvulsants, electromagnetic stimulations, electrodes, botulinum toxins, detachments of tight muscles ... and information, a lot of information. We must make the citizen and the professional be aware of it. Workshops, conferences, campaigns, international days for pain ... but no word is said about the risk of information.

"I swear to God, I'm astonished by this grandeur..."

Last week I was invited to a High School to speak about neurons and pain. Everything was new for the students. Their minds were as open for Neuroscience as for homeopathy or acupuncture. Their brains were already colonized by the alarmist culture of the “pain because of everything” and the “cure for everything”. I tried to warn them about indoctrination, acculturation, imitation of what is offered as sacred without further argument than the identity of belonging. Science against market and culture. Freedom from the critic, explorer, rigorous knowledge.

The brain is very interesting and sells audience in the media but we must move the media away from our bodies. It's a mental thing, not a body thing. Health is not a game. No speeches. Solutions, solutions ...

"And then straightaway

he put on his hat, brandished his sword,

sand with a sidelong glance, stole off."

Pain, depression and helplessness

Helplessness is produced when something that affects one isn’t comprehensible, predictable or controllable.

Unjustified chronic or recurrent discouragement or pain meet those conditions.

There is no adequate interpretative framework. The “when”, “how much”, “where” and “why” are not predictable, and the sufferer has no resources to control it.

The sufferer is not only helpless, but judged and convicted in a certain way because it’s considered that he has reached this situation by himself (genes and bad self-management). It’s also expected that the unprotected, given that he can’t overcome it, carries the situation with dignity and doesn’t disturb other’s good vibes.

The aching-discouraged person doesn’t understand what is happening. They are telling her she has nothing. There is no reason for wail and reluctance. It's an impossible situation to overcome. Being well and feeling awful. That’s why the sufferer prefers doctors to find something, to give her disease labels. Labels that don’t contribute anything. They rather strengthen the helplessness. They contain the condition of the stigma, the unsolvable. They refer to past mistakes or mysterious ailments. The label relieves when it’s received, but mortgages in medium and long term. It precipitates the condition of disability (if successful in achieving it).

Pain and despair emerge in an unpredictable, chaotic way. The sufferer uses the breaks to get a fleeting breath of life before the suspicious eyes of the fellows that don’t understand how one can have the nerve to live with pain and apathetically. The brain participates in this condemnation and waits to the end of that break to apply the punishment for the ad lib of disease.

Sufferers are showered with remedies and tips, balms and encouragement, generally useless. The fellows are upset by the resistance to improvement and shrug with a clear conscience of having done everything in their power and with the suspicion that the sufferer is not "doing his part".

The professionals are optimistic about themselves. They proclaim new remedies, spectacular advances. They show pictures of the brain, making the deficits and excesses blush.

The sufferer is confident, especially if she is a beginner in the condition. She tries everything with decreasing hope and money. Her suffering advances in direct proportion to what the promises of a solution are said to advance.

The body becomes the jailer of the sufferer. This person has become incompetent and dangerous, someone who should not be granted opportunities, as nothing good is expected seeing the status of the muscle-skeletal system, the serotonin, memory, energy and fellows.

Pain and discouragement are the hired assassins of a catastrophic brain who prefers to see the individual in a cage. The helplessness lets the cage doors be open. No guards are needed. The sufferer has resigned to flee. He only wants to be left in peace in his retreat, brooding his helpless condition in which nothing is understood, predicted or resolved.

It’s hard to push the helpless, make them see that they should react, try to understand, predict and control.

- It’s not a disease. It’s your brain. It has built an idea of a helpless, vulnerable, incompetent body. The brain is a virtual organ, like the immune system. They often see danger and failure where there isn’t. Don’t collaborate with them when they are wrong.

Defend youself.

Pay attention...

It’s assumed that the sufferer goes to the doctor’s office with many questions to ask, eager for quality responses.

The patient exposes his symptoms, condition, disability, the way in which pain is marking his anguish.

It seems that the presentation is over and it's time for the professional to give explanations.

- Tell me, doctor ...

- Let’s see...

One has to be paying attention to capture the lack of attention. The sufferer may still be entangled in his story looking for more and more details.

- You’re not listening to me ...

- Yes doctor. How wouldn’t I listen to you...!

- Well, what was I saying?

The patient has retained some sounds and repeats them, but has not grasped the concept that one wants to expose. He wasn’t paying attention to what he had to.

Without attention, the brain catches a few unconnected words over which later it reconstructs a story from its expectations and beliefs.

- I've been to a neurologist. He told me that...

If one hasn’t paid attention, what is said to have been said, in fact, corresponds with what one says to oneself about what another one is supposed to be saying. We are slaves of our narrative. In it, we put the characters with their dialogues...

- I told him, he told me...

It’s advisable to make a minimum of checks.

- Let's see. What basic idea have you caught?

In many cases you’ll get the surprise that none has been recorded or, even worse, you have managed to record right the opposite of what one was trying to explain.

- The brain ... hurts because I want it to hurt ... it’s psychological ... I get obsessed ... I’ll just forget that it hurts...

The commitment of active listening is required. The attention should be focused on what the professional is attempting to communicate, free of preconceptions, pre-meditated interpretations.

- Pay attention. Switch yourself off and listen. If you disagree or don’t grasp the content, let me know. Ask.

The office is, sometimes, a classroom. Sufferer and professional take turns in the roles of teacher and student.

- Listen to me, pay attention. I’ll explain my pain to you.

- Now you listen to me. I’ll explain the biology of pain ...

I vaguely remember an extraordinary book about muscle diseases. As time went by I’m only left with the thought I started the prologue with:

"Listen carefully to the patient. He’s trying desperately to tell you what’ss happening ..."

Absolutely agree, but it should be complemented with another similar thought for the sufferer:

"Listen carefully to the professional. He’s trying to patiently explain the reason of what’s happening ..."

Well, let’s suppose this is true, at least in some cases. Don’t miss them.

Receptors of consummated or imminent necrosis

There are no pain receptors. Only perceptors, ie, suffering, receiving, addressee individuals of that hurting event that arises from the brain to catch your attention and behavioral involvement in a threat assessment. Danger! Pain!


What DO exist are the ones called NOCI-CEPTORS by Nobel Laureate Charles Sherrington: noxiousness detectors. That was back in 1906.


Nociceptors are neurons that specialize in the detection of states and agents with a violent destructive capacity: extreme temperatures, mechanical energy that’s higher than the physical strength of tissues, acids, lack of oxygen ... Danger-detecting neurons are distributed over the surface and inside of the body and on their terminals they have receptors or sensors of dangerous stimuli. The receptors are proteins embedded in the membrane that, when contacting with a noxious agent, suffer a transformation that leads to the opening of a channel through which ions enter, ie, an electrical current. This electrical signal is transmitted to various processing centers and contains information on risk in a particular point. The danger may be mechanical, thermal or chemical.


Under normal conditions, nociceptors are only stimulated with what violently destroys tissues. If there are no extreme temperatures, acids, low oxygen or destructive mechanical stimuli, no signal is generated. There are no alerts of damage projected to the brain. Usually, the projection of pain doesn’t arise from the brain. The alarm doesn’t go off.


When a noxious agent has destroyed tissue, the dead cells (necrosated) release molecules that induce a change in the sensitivity of nociceptors. They make them respond to innocuous stimuli. Touching a wound generates a signal in sensitized nociceptors. Information on activated nociceptors reaches the brain and the brain projects pain on that area. While proceeding to repair the injury, the area is sensitive, with the population of nociceptors adapted to the state of vulnerability.


As the injury is being repaired, nociceptors go back to their basal state and innocuous stimuli stop generating signals. The brain is no longer informed with news of danger. The brain doesn’t project pain, it warns. The individual resumes normal activity. End of the repair process. Tissues in condition to be used. Innocuous stimuli no longer activate the nociceptors.


Nociceptors respond to local, real, actual danger at that time and place. If there is necrosis (violent cell death) or if it’s about to happen if the conditions don’t change inmediately, (I quickly move my hand away of the burning pan) the danger and consummated necrosis sensors generate a signal and, predictably, this will be enough to activate the perception of pain from the brain.


Nociceptors also respond to the prediction of danger from the various processing centers. The indication of warning, vulnerability, can be generated from above, memory and prediction systems and induce sensitization. Innocuous stimuli will generate a signal of nociceptors even when nothing dangerous is happening.


The central alert states, activated by threat assessment in the absence of consummate or imminent harm, facilitate the traffic and generation of nociceptor signals. The pain is projected from the brain in advance with no need of prior injury notifications. There is only prediction. Enough to activate perceptive messages of pain.


The central alert ends up sensitizing all the layers of processing, from the nociceptors to the conscious individual (the receptor of pain). There are warning signals everywhere. From the individual (“it hurts me”) to the sensitized nociceptor that generates a damage signal without damage.


The pain only certifies an assessment of danger. It doesn’t certify damage and the danger assessment doesn’t have to be correct.


There is erroneous inflammation (allergy) and erroneous pain (migraine, fibromyalgia...). Nociceptors in erroneous pain are sensitized.


It doesn’t hurt because there are sensitized nociceptors in the erroneous pain. It’s not the nociceptors that are wrong and have been activated for no reason. It hurts because the nociceptive system as a whole has generated a condition assessed as threatening. This includes global sensitization.


Sometimes it’s all about the facts, the burn, infection, lack of oxygen, consummated or inminent necrosis. Other times it’s about memories, fears, uncertainty, misinformation, unjustified neuronal alarmism.


The professional must assess both factors: vulnerable tissues and/or sensitizing brains and try to deactivate alarms, giving back the normal condition to the tissues and a reasonable confidence to the assessment centers.


The goal is not analgesia at any price, but the recovery of the integrity and body management from a reasonable management of danger.


Maintaining the security of the building with a chronically turned on alarm makes no sense.


Neither does disabling the siren to generate the fiction that if it doesn’t sound, there are no thieves.


The nociceptor is not a pain receptor, whoever says so...

The mystery of the mysterious diseases

Migraine, fibromyalgia, are diseases whose origin and cure are unknown. That’s what they say.


Why it hurts so much and so often really is a mystery if what the doctors say is true: that there is nothing abnormal in the time, space and circumstance of pain.


- It shouldn’t hurt you.


It’s the same with pain and other perceptions.


- I’m hungry every day and every hour.


- You shouldn’t be hungry. You are well-nourished. Over-nourished, I would say...


It’s the mystery of why some citizens’ hunger increases when they eat, rather than diminish it.


- I’m more and more hungry. I don’t understand it. No food fixes it...


The brain is a perception manager. It projects hunger, pain, heat, cold, dizziness, fatigue, boredom, euphoria ... for reasons that we don’t always understand. If we have been several days without food it’s understandable that the brain reminds us, with hunger, that the body needs energy, but it doesn’t make sense for the brain to project the urge to eat on us if we are a little overweight.


The disease of chronic, unwarranted hunger is a mystery. The researchers track the chemistry of hunger in search of molecules that turn the need into a compulsive addiction. They always find one and make the media bells sound.


Those molecules are also found in that kind of pain.


The researchers are optimistic.


- In recent years there has been considerable progress in the understanding of pain. In the future we’ll have new drugs. Controlling the suffering won’t be a problem.


The problem of the future is that it’s never present in this issue.


The issue of hunger is not improving. Every day thousands of people die because of chronic insatiable hunger. The problem may even be getting worse.


The pain also wreaks havoc. Every day thousands of citizens die by chronic, insatiable consumption of analgesics. The problem may even go from bad to worse.


Reasonable, economic management of perceptual resources is not guaranteed. The brain doesn’t have a smart natural condition. Rather the opposite. It’s the individual’s job to channel the brain’s biological dynamics, selected for harsh and competitive environments, and adapt them to the universe of “everything is a hundred yards tall” and be safe.


There are children hunger and chronic pain, insatiable.


Some believe that everything is because of the inconsistency between what the alarmist genetics claims and what the culture of abundance offers. The human molecules of pain and hunger are the same as those of flies and worms in the laboratory. We should to track the differences between cultures.

- Culture, you say? Children have no culture, but they have migraine and fibromyalgia. It’s the genes and the undisclosed mysterious thing. There are entire families affected by this.

Curious and erroneous idea of culture. It seems that there can’t be cultural impregnation until we access the "use of reason".


The sapiens brain (ma non troppo) is, by what genetics dictate, candid, imitating and “schoolable”. It absorbs culture since the first hours of life.


Parents, teachers and friends are always around the child projecting words and examples, said and dones. The child's brain is a pasive schoolchild that takes everything that happens and hears in order to process it according to rules we don’t know about.


This week a patient came to my office with migraine, neck pain, rather chubby, moderately discouraged and she was a smoker. She did a good job of schooling in "my brain and it’s “I”" ... She no longer has migraines, her neck doesn’t hurt (there was also a great pedagogical work of two excellent "neurophysic therapists") she has earned a few anti-kilos, she is courageous after quitting the antidepressants she no longer absurdly inhales addictive toxic smoke..


She is an ideal patient, intelligent and hardworking.

For her there is no more mystery. It's all simple.

Pain perceptors

Pain doesn’t exist without an addressee who feels it, a perceptor.

The perceptor of pain is the individual in conscious state. The brain can turn on and off the individual’s consciousness. If there is no consciousness, no pain is possible.

- The pain wakes me up at night ...

The phrase is not correct. No pain is possible while one is sleeping. The same happens with general anesthesia. No patient wakes up in the middle of surgery due to pain. The anesthesiologist is the one who decides to wake up the patient, thus allowing what the brain is projecting at that moment to reach consciousness. For example, pain. The brain gives and removes the general anesthesia. Turns on and off circuits that generate a perception in the real space-time.

- I don’t think it hurts when I’m asleep.

The idea that the pain arises from tissues is deeply rooted. The tissues are there, day and night. If they hurt, for any inconvenience, it wakes us up ... but it’s not true that pain arises from tissues. It always arises from the brain. Before the brain, there can’t be pain. After the brain, anything is possible. An amputee arm can hurt, an arm that no longer exists. It's called the "phantom limb pain".

- Think it doesn’t hurt and that way it will hurt less ...

The pain perceptor can’t impose its will. As much as one wants to imagine that it hurts, it doesn’t. Imagination can’t dissolve the perceived pain either. You can’t open your eyes in front of a person and imagine that that person doesn’t exist. Neither can you imagine the person and see him, as if he were there.

- The pain receptor...

There are no pain receptors no matter how much the texts in which Medicine students are instructed keep quoting and describing them. There are perceptors, ie individuals. Pain is a private, exclusive matter of the individual in a conscious, perceptive state. There are no receptors for Chanel No. 5 or fried eggs. Only perceptors, individuals who perceive the scent from their own brains with their exclusive screens.

What is a pain perceptor?

We have no idea. Consciousness is a mysterious area, unattainable at the moment.

Consciousness is an attentional state of the brain. There, it’s projected what at that time, place and circumstances the brain selects in order to propose a specific action to the individual.

It hurts, so the brain projects a proposal of defensive behaviour on consciousness.

You are hungry, so the brain proposes to take a bite.

It itches, so the brain proposes some scratching.

It stops hurting, so the brain has ceased to assess threat.

Painkillers don’t protect the tissues. Rather the opposite: they make them vulnerable. If the pain subsides with any therapy, it’s not because what hurts went back to normal, but because the therapeutic action has made the brain modify its assessment.

The cerebral projection of pain has its moments, places and circumstances represented in memory systems. A weekend is just another moment. It doesn’t contain any ingredients of injury on the head, in spite of all the stress accumulated at work from Monday to Saturday. If the weekend is coded as "danger", "alert", on Saturday morning the pain perceptor will receive the message.

Researchers are striving to discover new drugs that block the supposed pain receptors. Strange task to block something that doesn’t exist.

We should find a way to neutralize the perceptor by diverting their attention to a particular task. Sometimes it’s effective. The ideal would be to act on the pain projector, on the brain, deactivating the plot of the expectations and beliefs that feed that cerebral proposal of protecting something from a phantom, nonexistent threat.

We have a thousand possible ways of tricking the brain, but there is only one to make it see what is really happening: explaining to it that in the absence of injury, wherever it hurts, NOTHING happens.

Rationalize

- I think I understand. It makes sense. I think what you explained is true. But... what should I do?


A patient with migraine came to my office. Sitting next to me was a resident that was skeptical about the approach.


- How you doing?


- Okay. I haven’t had any more migraines. I don’t take meds. Sometimes I feel some pain but I control it.


- Explain to the doctor how you do it...


- I rationalize. I think quickly about what I’ve learned. I know that nothing is happening and I concentrate on what I'm doing.


We are instructed in the idea that something should necessarily be done to dissolve the pain. That something may be introducing a molecule with supposed powers to neutralize a supposed chemical responsible for pain: a needle, a herbal infusion, homeopathic products, meditation ... Something added, aimed specifically at returning to normal.


In my office, I explain the basics of neurology of pain. Two objectives: dissolving errors and providing reliable knowledge. The perception of pain without justification has been activated. The brain has overestimated the probability of a destructive event. It’s not true that there is necessarily something wrong. The evaluative error is enough. False alarm. The apparent effectiveness of the reliever just indicates that the brain required the action of taking it and that this has dissolved the (wrong) assessment of threat. Nocebo to activate the alarm and placebo to deactivate it.


- Why does it hurt?


- Nocebo effect.


- How do I fight the nocebo?


- There are two ways: with placebo (doing something) or the conviction that nothing happens.


- I know that nothing is happening but even so... it hurts. At the end I have to take the painkiller. I need it.


Under experimental conditions we can get that when an inert cream is applied to the forearm before undergoing stimuli generators of pain (laser, heat ...) the pain perception increases or decreases by changing one word of information:


- With the cream, you’ll feel less pain ...


- With the cream, you’ll feel more pain ...


It’s the same cream. A spoken word is a mechanical stimulus that generates a wave train that the ear captures ... A change in the wave train is enough to increase or decrease pain. We can write information: more... less... In this case the word generates a subtly different light stimulus, sufficient to induce more or less of pain.


The pain therapies activate previously built expectations, by own experience, observing others' experiences and instruction.


The observation of an analgesic action by placebo facilitates the placebo in our own flesh.


The duration of pain after the application of noxious stimuli varies if we trick the clock (one lap of the hands in 45 seconds.)


Knowing that a placebo was given doesn’t eliminate the analgesic action. The brain calls for action even knowing that such action doesn’t have anything relevant. Placebo. Deception.


The pedagogy of pain seeks to dissolve the false belief networks that feed the activation of false alarms. It seeks to dissolve the “nocebo-ness”, informative and cultural viruses. One of those viruses is the one that requires the therapeutic action, the cleansing ritual, the antidote to what (supposedly) makes it hurt.


The antidote for the nocebo is not placebo but the anti-nocebo, the anti-virus, not the virus of opposite sign.


- I understand, but I don’t know how to change my mindset...


- You’ll need to find out.


As Sol del Val said, everyone has their personal migraine and should explore it from the new interpretive frame provided by neurobiology.


Paradoxically, the patients with most migraines, most rebellious to treatment have a better response. They work in advance. They have tried all the therapies and are already disappointed. They need something new, different, contrary to what they so far have been provided.


Rationalization doesn’t have a good reputation. We forget the emotional part. There's always someone ...


An emotion is a state in which the organism assesses relevance, transcendence. Pain is the expression of the most powerful emotional state of the organism: the possibility of cell death, necrosis. Irrational fear is fought with rationality.


- I rationalize. I think about what I’ve learned. I continue with my homework.

Me, myself and I

- I don’t want it to hurt.


It’s a precision that I often hear in my office. My attempts to explain the biology of pain, the cerebral imaginative process, fail in many cases. The “I” of the moment has felt alluded and has misinterpreted the speech. The victim has felt pointed out as guilty.


- It’s not you. It’s your brain.


- My brain is ME.


- Yeah, right.


If it hurts it means that the brain assesses threat. It’s a system of neurons from which states of connectivity emerge, groups of synapses (contact points between neurons) that sizzle at the same time, generating different perceptions. Pain is one of them. The brain "decides" it hurts. It wants it to hurt. It wants it because it considers that the individual should put aside his or her issues and focus on the danger that at that time, as predicted by the memories, is in a body area.


- I don’t understand why MY brain would want ME to suffer.


- YOUR brain has been selected throughout evolution to, among other things, ensure the safety of the organism. It does that by creating hypotheses of danger, uncertainty, risk, probability. It's like your bodyguard. Don’t ask it for rationality. Fear isn’t always rational. Brains are fearful, depending on how fearful or daring the individual living in that body is.


- I need a solution, something to take away the pain. Last week I had to go to the emergency room to have someone give me meds.


- We must do something about your brain. Calm its absurd fears. The pain intensity is telling you to what extent the brain is scared. If you must go to the emergency room it’s because your brain requires it to calm down.


In security issues, we can easily access the unconscious, without hypnosis, divans or deep meditations. Somatic perception shows meanings of neuronal processing. Hungry? the brain wants you to eat ... Itchy? your brain wants you to scratch yourself... Pain? your brain wants you to stay still and take YOUR reliever ...


The function of pain is not to delve once again into the wounds of the individual, as interpreted by the defenders of somatization or the psychosomatic. If the head hurts it’s because there is cerebral, somatic fear to something physical, terrible, happening at that time in the head. If it hurts after a heartbreak it means that the brain considers the heartbreak a threat to the physical integrity of the head. Neither food nor hormonal changes, or the hassles at work or sentimental failures contain the immediate risk of causing a brain hemorrhage or meningeal infection.


- Yes. I DON’T think so.


- Yes ... but your brain is acting "as if" all those triggers contained that threat.


The situation is similar to the one of the Immune System, the other alarmist system that sees danger everywhere ... until proven otherwise. The vigilant immune cells carry in their membrane protein receptors-detectors. Each cell clone is dedicated to detecting one of them. It fixes it on the membrane, digests it and presents suspect areas that should be assessed in the network. Sometimes that protein is the cat’s, pollen’s or house dust mites’. If the immune “brain" believes that this protein belongs to a hazardous agent, it will decide to release the production of the clone to defend the body from an imaginary, absurd danger. Neither the cat, nor pollen or mites release germs, but for the body, for the immune system, there is danger of infection.


The “I” doesn’t have problems accepting the responsibility of YOUR immune system in an allergic reaction, but the same doesn’t happen with YOUR brain. It doesn’t let other people talk badly about it. It feels alluded.


- It can’t be MY brain. I'M not like that...


Yesterday I saw a patient that had come three years ago because of migraine. After the first visit, she decided not to come back. She went around taking painkillers, needles, homeopathy, herbs, diet, yoga and others until she ended up in the emergency room and had to come back to the Neurology office.


- I don’t want it to hurt me. What I need is a solution.


I think she finally realized that she hadn’t understood the first time she came. I’ll tell you how it goes...


The SELF is tough. The brain is a tricky construction. Otherwise the brain could not make the individual do whatever it wants:


For example, going to the emergency room for some meds ...

Neurovigilance

The brain exists because it has helped us survive as individuals and as a species. The massive brain of the sapiens (ma non troppo) is there because it proved its value as a navigator through the uncertain world of evolution.


The sapiens (m.n.t.) brain was born with many circuits but with a lot to learn. The programs’ modulation is pending: the what, when, how, where, why and for what of almost everything.


Before there were neurons, the immune system cells used to detect proteins-signals of danger (germs, cancer cells, uncertain cells, cell corpses). They would only respond in the presence of those signals. Often, too late.


Neurons provided the possibility of establishing a correlation between physicochemical signals of all types and potential danger before the harmfulness contacted the organism. Neurons had the ability to convert the internal and external variables into appetitive reflex actions (food, family) or aversive (predators, fire, traumas). Distant smoke that gives away the fire. Smell, sight, hearing, touch, taste, attributed value to the environment promoting adapted behaviours of rejection or getting closer. All this with time and space between them. Warnings, premonitions ...


Immunovigilance analyzes the danger of the agent by feeling its molecular signals of identity with the receptors of the vigilant cells’ membrane. The neurovigilance feels the agents through physicochemical variables that they generate in the environment: reflected light, mechanical vibrations, volatile substances. Neurons see, hear and smell the danger before it shows up.


In many cases, the dangerous agent appears docked to harmless states and agents. The neurons take notes of the scenario in which there may be something relevant, positive or negative and register all types of signals that coincide in time and space with it. If immediately after the sound of a bell the food arrives, hearing the bell will be enough to make the salivary glands to start salivating. If we associate the sound of a bell with an electric shock, hearing the bell will be enough to run away. Hearing bells is both for activating the salivary glands and activating the fight-flight response.


Neuronal preventive capacity gained from own experience was expanded through distant observation and covered from the adversity of others. Neurons learned how to sense the harm in others’ events. It’s an emotional, empathetic feeling. Otherwise it wouldn’t be useful.


For the sapiens (mnt) brain, all those features of the conditioned reflexes (bells, saliva and electric shock) and empathy with the exciting events of others weren’t enough. We are a fragile and vulnerable species, without armor, claws, poison or speed. We need more security.


Living things associate when they feel threatened. They turn into multi-individual organisms, societies, following informational signals that express stress, adversity that is unbeatable on their own.


Then, sapiens organized in bands that increased and/or reduced capacities. Something to share was, undoubtedly, information. The sapiens (mnt) brain became compulsively gossipy, nosy, story teller, plus imitative and empathic. Now not only could it sense others’ events by seeing and hearing them from a distance. The story inside the group appeared, in the heat, in the place of the events and and in the cold, in the den. Gestures, shouting ... and finally, language.


The sapiens (mnt) brain needed time and rest to process all that huge amount of uncertain signals about danger. Sensations, observations and stories ... Too much uncertainty ... It promoted space-times of ruminant reflection of all that material, all that the conscious and alert individual let free. Dreaming, sleepiness, mental wandering are universes in which the brain seeks order, regularity, analogies, associations, causes, probabilities.


The representation of the world in a virtual, dreamed, imagined environment, generated new hypotheses that proposed a theory of events, their causes and remedies. Some individuals were born touched by the ability to sense, guess, interpret, predict, advise.


Their imagination created doctrine.


Expert and/or illuminated information provided certainty and uncertainty to the network.


The vigilant brain integrates all those evolutive levels of knowledge (own experience, observation of others’ events, stories, doctrines) and turns on perceptions, emotions and actions while all that complex imaginative world assesses at each space-time the probability of an event.


The neurovigilance needs rest to order so much information, but maybe it needs, above all, a criterion to filter incredible knowledge.


Newton gave mechanical order. I’m not really sure of what Einstein said. For many people, he opened the door to free will. Everything is relative, they say he said. Some believe that this authorizes any proposal of truth. Everything is true and false. You choose. Freud warned about the brain basements but opened the door to somatization as a universal explanation. Darwin reminded us that we are shared history.


Perhaps we already need a substantial blow of knowledge in such an important subject as neurovigilance. Perhaps we need to know about the socialized, educated, culturized brain,.


At the moment they speak about evolutionary botch jobs, about proteins that reuptake serotonin, the drug of happiness, thus preventing our good mood. Luckily we have found the necessary antidote, the inhibitor of serotonin reuptake. That way, the serotonin will stay a few more milliseconds in the synapses, blowing sanity and happiness.


Someone suggested more Plato and less Prozac. I’m not sure. I'll stick with Newton and Darwin. I don’t get Einstein and Freud’s somatization doesn’t convince me.


For now, I’m glad that I have a protein that reuptakes serotonin.


Prozac? No, thanks.

Primary and secondary pain

The “classifiers” distinguish between primary and secondary pain. The latter arise as a result of damage in the place where we feel pain, and the firsts appear without us detecting anything relevant where it hurts.


There are primary headaches (migraine, tension headache ...) and secondary (tumor, hemorrhage, bump ...).


Primary pain is supposed to have origins, even when they aren’t tangible. Migraine, they say, arises from some genes that build hypersensitive cerebral generators of migraines. Tension headaches are generated by states of anxiety, nerves that contract muscles excessively. Primary pain is actually secondary. The pain comes from something. That’s what the patients always say.


It’s not clear whether the "spine" pain is primary or not, without a tangible cause. If something hurts, it’s taken for granted that one’s lower back or neck isn’t well. Mechanics, loads, physical effort, postures, wear, years are what matter. The "bone pain", depending on the point of view, is primary or secondary.


- My bones ache ...


The statement stands for itself. It could be a primary pain derived from the condition of the bones, which is hurting themselves.


- The bones don’t hurt ...


If one wants to lose the confidence of the patient, all he/she has to do is that staggering claim. However, it is so. Bones don’t hurt. The pain may arise from harmful events of the bones, events that generate neuronal signals that reach the brain areas able to project the perception of pain in the conscious display of the individual. The "bone pain" would, therefore, always be secondary.


- When the weather changes, my bones can feel it.


Time is to the bones the same as nerves are to the head. The primary headache would be secondary to the overwhelm, and the primary bones would be secondary to the cold and damp.


Something similar happens with discouragement. Depression can be primary, without an apparent reason, or secondary to a depressing event. Psychiatrists prefer to call the primary endogenous and the secondary exogenous.


I've never understood the difference between endogenous-exogenous or primary-secondary. What is perceived is always the result of a complex cerebral evaluation process. There is always a decision of the network.


- I have a primary pain for no reason. They say it’s the brain, which has its reasons to turn it on, but I don’t know them. The MRI is normal. There really is no reason. The brain is wrong.


- Exactly. The primary pain is a secondary pain to an erroneous cerebral evaluation.


There are primary and secondary people. A primary person is someone we can see without there being a person. If we take a picture of where we see them, they don’t appear in the picture. A secondary person is the one we see for the simple reason that he or she is really there. He/she is in the picture.


- A hallucination?


- Yes.


There is primary pain in the absence of states and agents that activate the nociceptor network. We are sorry, but on the area of the disease there is nothing relevant, harmful.


- A hallucination?


- Technically it is a hallucination, but don’t go around saying that...


Pain without harm, hunger without malnutrition, cold without low temperature, loneliness in a crowd ... are primary. The necessary and sufficient objective condition to be explained and understood is not given.


I don’t like the classification of primary-secondary, endogenous-exogenous. I prefer to distinguish between perceptions-right productive choices, and wrong-unproductive.


There is pain, discouragement, cold, hunger, dizziness; unnecessary, disabling, sterile, pure pathological tiredness. They are secondary to an erroneous assessment of relevance-probability, that is ... primary, as “classifiers” claim.


There is pain, discouragement, cold, heat, hunger, tiredness ... that are necessary, convenient to guide the behaviour of the individual in the right direction. Secondary, exogenous, justified ...


The content of what is perceived does not guarantee its objectivity. There may not always be people where we see them. People may not always be where we see them. The MRI may always be normal wherever we feel pain.


- There is a threatening man in the living room.


- Let's see ... There’s no one. He’s a primary man...


- What do I do? What do I tell him to go away?


- Don’t pay attention to something that doesn’t exist. If you do so, you’re lost.


Checking account balances are sometimes negative. Classifiers distinguish between the primary negative, which appears without one finding the reason for it, and others that arise after a lavish expenditure.


Negative checking accounts express the balance between what goes in and out over time. The usual expenditure is enough for the alarm to go off, without us getting any benefit from it.


The brain manages our account. It doesn’t need to run out of money. If it considers that we shouldn’t spend it, it blocks our account without further explanation.


- I’ve been feeling discouraged lately. I don’t get it, everything is right ...


- Everything hurts, always, and they can’t find anything.


The primary is that way... Homo sapiens (ma non troppo) is perhaps a more primary species than we think ...