Where is the pain? The teachings of philosophy and neuroscience   January 1st, 2015

During the last decade there has been much discussion about pain and its manifestations, their presence and, naturally, their absence. As physiotherapists and health care professionals we have taken tools from other disciplines to advance in our own; we adopted neuroscience (for understanding the functioning of our nervous system) and philosophy (for understanding how the mind works). In theory everything is clear to us, but in reality our knowledge does not always correlate with clinical outcomes.

Mistakenly we believed for years that we left behind the Cartesian model to focus on the nervous system, and that we left the biomedical model to focus on the individual (like Descartes trying to left the fallacy of the homunculus making the same mistake between the soul and the pineal gland). Our approach is old wine in a new bottle. Not only we still think dualistic, we continue to work as mechanics too. The philosophers Hacker and Bennett have called this mistake as mereological fallacy, which is summarized in taking a part for the whole (Bennett, M & Hacker, P (2003) Philosophical Foundations of Neuroscience. Oxford: Blackwell). As Wittgenstein said in Philosophical Investigations, “only of a living human being and what resembles (behaves like) a living human being can one say it has sensations” (Wittgenstein, L (1953) Philosophcal Inverstigations. Oxford: Blackwell; I, § 281).

What we now know is that the nociceptive nerve endings do not detect pain, but signs of damage, i.e. danger. The muscle, bone, joint or ligament does not hurt, and contrary to what has been thought in recent years, neither hurts the brain. While nociceptors detect signs of damage, and from the brain connections arise to other areas where perception is completed with affectionate, interpretative, motor, attentional and behavioral touches, pain is the result of the joint activation in synergy with its projection into the consciousness. As is clear, we cannot expect a structure to be responsible for pain as well as we cannot expect a solitary individual to play a soccer match.

What philosophy and neuroscience really teaches is that the mind is the result of brain functioning. Identically a running car is the result of engine operation. The movement and the energy that drives the engine and the brain is ultimately a manifestation of matter as well as keep awake at work is a manifestation of coffee and breakfast. On the other hand, and this is important, it is as many complex systems that have a material substrate, they have laws that are generated within the same complex system governing interactions between different minds. Thus the reason, the pain and even feelings, do not obey the laws of Newton or Einstein's relativity or the Cartesian theory. Mental systems follow their own laws that emerge from the complexity of the system and therefore we cannot conceptualize universally. Everybody thinks differently, loves differently, and hurts differently.

Pain is just the conscious component of a complex system of self-defense. That’s why it is a mistake to think we can understand the pain generalizing the concept or think that the location of pain is in the tissues, or in the brain; pain is a little tangible concept as money, which is not in the coins. The pain is a result of the operation of a complex system manifestation of matter only within the system that creates it. There are people with pain, but there are no structures hurting. Likewise, people can be thirsty, but thirsty throats do not exist. Every pain is different, so the perfect treatment does not exist, what does exist is the treatment that your patient needs.

Zahim Rafael Escamilla Ugarte 
Rafael is a Mexican physiotherapist and science researcher. He is widely interested in art, pain, evolution and neurosciences. In his spare time he reads poetry. Rafael can be contacted at: @RafaeIUgarte https://twitter.com/RafaeIUgarte