No brain, no pain

“No Brain, no Pain” is the kind of statement that could sound politically incorrect on first impression; however, it is 100 per cent accurate from a neurofunctional standpoint. It represents both the paradox of pain and the neuro-reality of pain. Understanding both dimensions is mandatory to succeed in managing musculoskeletal pain effectively, particularly chronic pain.

What is the paradox of pain? The fact that pain, specifically musculoskeletal pain, is perceived as if occurring in the body, while in actuality, pain is mostly the result of complex neurological activity in the brain. Surprisingly, we do not need a body part (or a body at all) to experience musculoskeletal pain; all we need is a brain.

We can state that literally “pain is in the brain”, one of the hardest concepts to understand by musculoskeletal pain sufferers and even health care professionals dealing with these problems.

Understanding neurofunction can be a true challenge, as our common experience of pain is always associated with body parts. Pain seems to come from our back, neck, shoulders and other body parts.

Neurologically, this perceived physical experience is literally an illusion, a very effective tridimensional illusion crafted by our highly evolved brains.

This fact, the existence of an individual neurological reality created by our brain, has been well established empirically by the example of many individuals suffering phantom limb pain (experienced in the absence of the actual limb), as well as by data collected during brain surgeries in which patients were awake. In those patients, direct electrical stimulation of different brain parts elicited a wide variety of sensory experiences such as the smelling of odors, the viewing of lights, and the feeling of different forms of skin stimulation, such as pressure or warmth.

Interestingly, this is the very nature of every conscious experience: it is all the result of brain and central nervous system activity. We live literally in a crafted neuro-reality, and our experience of the world—including what we call pain—is the product of our brain activity (of course, using input from the body parts and the environment).

All this sounds very interesting, but…what difference can this “neuro” talk make in clinical practice for pain sufferers and health care professionals? Actually, it can make a significant difference in the clinical approach to musculoskeletal pain problems.

Our growing understanding of the pivotal role of the brain on the pain experience, and the simultaneous development of a practical neurofunctional pain model, is quickly liberating us all (patients and practitioners) from the limitations of the (still widely used) musculoskeletal pain structural model, where specific body parts (the joints, the rotator cuff, the back) are blamed for the majority of the pain experienced by the patient, even when treatment of these body parts frequently fails to provide pain relief.

Instead, the neurofunctional approach takes into consideration the most important dimensions known to be involved in the production and maintenance of the pain experience, such as global nervous system activity (autonomic, somatic, peripheral, central, etc.), metabolic and nutritional state, endocrine status, immune system status, psycho-emotional and psychosocial status, joint biomechanics, soft tissue nutritional state and directional loading behavior, and few others.

A neurofunctional analysis of these dimensions tries then to identify the impact on the activities of the nervous system. The final goal of the analysis is to select neurofunctional treatment goals and targets, which are different from traditional structural targets such as joints or muscles.

Neurofunctional targets include peripheral nerves, distal arteriolar networks, and posterior rami on the paravertebral musculature. Through these neuro-structures the central nervous system activity can be modify, with a positive effect on both central nervous system function and peripheral tissues function.

Modalities with a powerful effect on neural function include neurofunctional electroacupuncture, soft tissue manual techniques, nutritional interventions, behavioral modification, and specific strength and conditioning regimens. Of these interventions, neurofunctional electro-acupuncture and manual therapy interventions (such as soft tissue and joint manipulation techniques) have proven to be the best suited to induce or facilitate neurofunctional changes that over time will result in improved cellular activity, both at the nervous system level and at the musculoskeletal tissues level. These improvements, in turn will have a positive effect on brain activity, changing the patient’s neuro-reality into a more functional and pleasant one.

The obvious corollary of the neurofunctional model is that since each individual has unique access to his/her own brain activity, it is always possible to modify our internal reality by changing the way we think. Reorganizing and reinterpreting our thoughts is the most powerful neurofunctional intervention, and taking charge of our brain’s activity is the best way of improving our neurological reality. No need to give up our brain to live without pain.