Daily Maestroism
DM #190
Tuesday, November 29th, 2016
DM #190: Spent the day learning from THE David Butler of @noigroup, and naturally had to make tonight’s DM about pain.
Pain is an OUTPUT, not an INPUT. What exactly does that mean? Well, the pain you experiencing after getting a paper cut that you swear is the worst thing you’ve ever felt, is NOT a result of pain signals being sent to the brain along pain fibers in the nervous system. No such nerve fibers exist. Pain is NOT something created in your tissues and sent to your brain.
Rather, pain is a result of ‘danger signals’ being sent from the tissue to the brain. The brain will then decide whether or not those signals warrant a response, and if they do, we experience pain. These danger signals are nothing more than an increase in amplitude and the number of impulses in some nerve fibers.
Why does this matter? Because if you’re at all concerned with treating pain, be it your own or your patient’s, then you need to understand that pain is something that is constructed in the brain when the nervous system PERCEIVES that there is a threat. It is NOT something that is simply created in the tissues. I emphasize the word ‘perceives', because we must take into consideration the entire human, and the fact that things such as memories and the environment will contribute to how a person perceives a certain stimulus, and thus whether or not they experience pain.
Yes, we must still put our hands on our patients. Yes, acute injuries do warrant localized treatment. Yes, sometimes ultrasound units (more correctly referred to by David as ultrabullshit machines) will make people feel better. But let’s understand the mechanisms at play and the fact that the research is showing us that the tissue that is actually injured may not be as big of a contributor to pain as we previously thought.
Head hurt yet? Stay tuned for more.
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