Neurobiological Basis for Chronic Pain
In reviewing all types of literature about pain, I sadly note the paucity of research from my field of Orthopedics. This is a shame since orthopedic surgeons have training in a number of sciences not commonly used in other medical specialties: Biomechanics, Kin-esiology, Gait and Balance, Functional Neurological Testing, Neuroanatomy, Motor Physiology, and Pediatric Developmental Neurology. In subsequent articles, I will describe how these sciences can be of use to all physicians in pursuit of better pain treatment for our patients.
What problems do I see with solving pain issues using a conventional, symp-tom-based, pathoanatomical approach? It works well for acute injury but, it does not work for Chronic Pain. Pain does not show up on a MRI. What is the specific pathoanatomy in Fibromyalgia? Our classic approach ignores the enormous compensatory ability of the human nervous system and how some functions are protected at the sacrifice of others. In other words, the symptoms may not reflect the most important pathology.
Chronic Pain is mostly the result of central compensatory strategies for survival, but pain itself is not a survival priority. The Brain will “accept” and deal with pain in order to allow us to bite better, balance better to remain on our feet, breathe, and see better. Bite, balance, breathing, and blindness (preserving eyesight; not going blind) are “survival priorities” programmed inside us. These biological priorities dominate in how we adjust to any present threats but not pain avoidance. It stands to reason then that our focus on pain symptoms is misguided.