What is the definition of pain? If you ask ten experts, you would probably get ten different answers. With all this confusion, the treatment of pain seems nearly impossible if no one can agree on a definition. Beyond just the definition lies the meaning of pain. What does pain mean? If you have a headache, does it mean you have a tumor? If your finger hurts, is it a paper cut or something more sinister?
The problem with uncovering the meaning of pain is the fact that pain is not an accurate indicator of actual tissue damage. Those who believe that pain accurately measures the amount of tissue damage are wrong. This notion is a common misconception about pain that arises from the belief system of many doctors and patients who base their conception about pain on the antiquated bio-medical model.
The black-and-white terms of the bio-medical mindset is akin to the feeling that if something is broke, it needs to be fixed. In other words, if something is wrong, take a pill to fix it. That treatment model works great for infections. But, many types of pain are not so black-and-white. Phantom limb pain (pain that occurs in a limb following an amputation) does not work that way. The limb is gone and yet there is still pain in that "phantom" limb. Or is the pain really in the limb? What limb? Yikes, this proves that pain is not a very accurate gauge about the condition of the tissues. Another example of the dichotomy between pain and tissues is that of spinal MRI's. Sometimes an MRI might look terrible and yet a person feels no pain. When the imaging study does not match the experience of symptoms, doctors and patients get very confused. Being stuck in an old operating system, the bio-medical system, must be very frustrating.
So, what is the definition of pain? The scientists at the Neuro Orthopaedic Institute have proposed a new definition of pain.
Pain is a multiple system output constructed by an individual specific pain neurosignature. This neurosignature is constructed whenever the brain concludes that the body tissues are in danger and action is required. Pain is allocated an anatomical reference in the virtual body.
Alright, let's break this new concept down into digestible chunks. Pain is an output, a signal that develops as a result of a perceived threat. The signal is meant to motivate the individual to do something. It is useful to think of this pain signal as being similar to the other signals in the body like thirst and hunger. The reference point for the pain signal lies in the "virtual body", the body map in the brain. Thus, even if the leg is gone, there can be pain in the "phantom" limb because the reference point for pain is in the brain map. This is a major conceptual shift about pain. In simpler terms: pain is an output from the brain, not an input from the tissues.
With this new definition, the treatment of pain becomes twofold: first, eliminate the threat; second, do something. When you are thirsty, you drink. When you are hungry, you eat. When you are in pain, you ____________(fill in the blank). For most people, I think filling in the blank with "improve your health" is most appropriate because the unhealthy, strained-by-stress state is the ultimate threatening "lion" in this world. Threats can come from any direction: the tissues, the thoughts, the belief system, the suffering, the social environment, and the behavior. To understand pain, one must move beyond the fix-it attitude of the bio-medical model. To understand pain, one must take on the brain.
This new definition of pain takes on the brain and it is worth repeating again. Pain is a signal output from the brain that is based on a perceived threat. But, even more important is the meaning of the pain signal because the assigned meaning is a primary source of suffering. If you think the headache means that you have a tumor, you will be very worried and anxious. If you think the finger pain means that it was amputated, you will be very worried and anxious. If you focus on the tissues, the pain takes on a bigger, more threatening meaning than might be warranted by reality. The head might hurt just because the hat is too tight. The finger might hurt just because of the paper cut. Lion or mouse; a threat is a threat. Sometimes the brain cannot tell the difference between a hungry lion and a hungry mouse. So, not every pain is related to actual tissue damage. Pain is related to perceived threat; therefore, pain is not an accurate measure of the amount of actual harm.
With this new concept about pain, treatment becomes more hopeful under a bio-psycho-social model. This treatment model not only focuses on the tissues, but also focuses on the brain. Identifying the threats as witnessed by the brain can open the door for more treatment options. Finally, everyone can move beyond the antiquated bio-medical model and into a more hopeful future. As patients, scientists, and doctors embrace the brain, the cure for chronic pain might be on the horizon. Embrace the brain, cure the pain!
Published On: March 10, 2009