New pain paradigms in the light of neuroscience

Descartes’s theory that pain necessarily came from pathological tissues and that it becomes conscious in the brain has now been eradicated.

Today we know that as a result of a perceived harmful stimulus in the tissues, a threat evaluation process is developed that causes a series of central phenomena that will trigger pain as a warning signal. Therefore, we can say that pain is an action of the organism, a behavioral consequence based on the beliefs, experiences and expectations of the person who suffers from it.

There can be three tissue contexts of pain:

  • Death or actual cell damage: there is a focus of necrosis (cell death) detected by healthy cells that will activate a response of protection and tissue regeneration.
  • Potential cell damage: A threat of possible necrosis is perceived and a prior avoidance response is triggered.
  • The imagined damage: lived as real and based on previously learned experiences. Incentives and harmless behaviors generate unnecessary alert-protective responses.

The three contexts synchronously activate multiple areas of the brain, involving the transition to the state of alert-protection. Therefore, we can say that pain is an output of the brain, not input. We should not confuse nociception (perceived tissue contexts) with pain (subsequently generated in response).

The pain is always real, and only the person who suffers it knows it. In cases of chronic pain, there is an absence of damage that explains or biologically justifies it, but there is an alert-protection system that evaluates and anticipates the danger, even if it is not there.

The fact of having suffered pain for a long time causes an attitude of hypervigilance due to the belief that this problem does not and will not have a solution. Knowing how the mechanism that triggers pain works can help us understand that our learning is the key to educating our neuroimmune system.

Health professionals should help minimize uncertainty and fear regarding pain, offering strategies (such as movement) to help learn new strategies that help restore confidence and self-esteem.

To finish, a reflection: «Let us return to the organism its desire to explore the environment freely, without fears induced by erroneous beliefs» Dr. Arturo Goicoechea.

Fàtima Sultan Hamudy / Policlinica Comarcal del Vendrell 

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