Role of the Brain in Chronic Pain: Painfully Absent in Medical Curricula


Home / Role of the Brain in Chronic Pain: Painfully Absent in Medical Curricula

Only the brain can trigger pain. Photo by alles-schlumpf

In spite of astonishing medical discoveries in the treatment of chronic pain, the faculty of medical schools in the United States and Canada largely ignore the study of pain management. The Neuro Orthopedic Institute in Australia is planning an international conference in  April 2012, in the hopes of promoting education about chronic pain among both medical professionals and the public.

Importance of Public and Medical Education about Chronic Pain

According to the Institute of Medicine (IOM) of the National Institutes of Health, over 116 million Americans suffer from chronic pain – this number is higher than the combined number of persons suffering from the chronic diseases: diabetes, cancer and cardiovascular disease. Chronic pain crosses the boundaries of disease states, and costs $635 billion in medical care and lost productivity each year, not to mention human suffering and diminished quality of life.

Chronic Pain is not Comparable to Acute Pain

Acute pain is successfully managed by the use of pain-killing drugs, usually opioids. Although family physicians and surgeons also prescribe drugs for chronic pain, these medications are not effective. Chronic pain may persist for years after tissues have healed, as well as in the absence of disease.

  • According to the International Association for the Study of Pain (IASP), as early as 1960 it was recognized that acute and chronic pain are entirely different phenomena.
  •  G. Lorimer Mosely, co-author of Explain Pain, by David Butler and Mosely, writes that for twenty-five years it has been known that many factors beyond actual tissue damage cause pain.
  •  Mosely explains that, in the case of chronic pain,  the relationship between the perception of pain and the actual presence of pain in the body are not identical, and, in fact, can be very different – even the opposite.

Astounding Discovery About Chronic Pain

The brain interprets nerve signals. Photo by Jilly

The Neuro Orthopedic Institute (NOI) is dedicated to research and education in treatment of chronic pain.  Years ago, a critical fact about chronic pain was discovered.  This revolutionary discovery is described in detail in Explain Pain.  Stated in simple terms:

In the absence of traumatic injury, the brain – not nerve signals – is the ultimate arbiter of whether or not an individual feels pain and how severe the pain will be.

Only the Brain Can Activate Pain

How does the brain decide whether or not the body will feel pain?  The answer is that the brain calculates the degree of danger to the survival of the human body, taking into consideration past experiences and memories of both pain and safety.

First: the brain can block pain signals, as in the following scenarios:

  • An ice-skater is performing at the Olympics.  He sprains his ankle but goes on to finish the rest of his routine flawlessly.  As soon as he is finished, the pain is so great that he cannot even limp on the ankle.
  • A person feels sharp pains and rushes to the emergency room.  Once in the safe presence of health care professionals, the pain disappears.

Second, the brain can activate pain signals when there is no injury:

  • A healthy employee finds out that a close co-worker has strep throat.  Even though he is not infected, his throat suddenly hurts.
  • Someone grew up before dentists had Novocaine.  As an adult, even after numbing with Novocaine, this person feels pain upon hearing the dentist’s drill.

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