Pain — Do We Really Understand It?

This article gets into some technical material. I have tried to simplify it as much as I can, while still keeping the substance intact. My goal is to communicate concepts about pain and scientific theories. Please read it for that purpose. Skimming the titles of each section will give you the gist of what I am saying. You can read the links for the gory, technical details.

In the past few days several members in Illumination have talked about their experience with pain.

Dr. Yildiz discussed the soothing benefits of Epsom salts, used for the aches and pains of the day.

Terry Mansfield describe the persisting pain that started with a severely fractured ankle. He was the victim of a hit-and-run car.

Julia Hubbel gave us some friendly suggestions about treating those pesky muscle knots that can occur because of slouched posture from a day of writing.

My Painful Thigh

I would like to add a few words about my recent pain event, but then discuss a fresh perspective on the biologic nature of pain and its neuroscience. In early March I began experiencing pain in my left buttock and hip area. It started in the muscles of the buttock and later spread to the side of the hip and then down the side of the thigh to the knee. It reached a peak intensity about 10 days after it started and has been gradually getting better.

Being a retired physician, I am well trained in functional anatomy. I knew what tissues it involved. Here is a more concise technical-medical description: The pain began in the left gluteus medius muscle. It migrated to include the trochanteric bursa (trochanteric bursitis). Finally, it moved down the length of the iliotibial band. These tissues us balanced when standing. They are very active, controlling balance as we swing the opposite leg when walking. At the peak of pain, the gluteus medius and trochanteric bursa would erupt into severe pain with only about a minute of standing. Fortunately, as with most soft tissue injuries, the body is healing and almost back to normal.

I have used time-honored techniques with controlled stretching within the limits of tolerable pain. I have not shied away from using the muscles and tissues involved, but I have made sure I could sit or crouch to relieve the sudden crescendo of pain that came on with standing. I used deep tissue massage, as best I could, since I had to do it myself. Deep tissue massage mobilizes the injured tissues and keeps them from seizing up. (I used techniques similar to those described by Julia Hubbel in her article) I also used a combination of Tylenol and an over-the-counter NSAID for pain control. With the medication, I could do more before the crescendo of pain made me stop. (The purpose of all pain treatment is to improve function and not to get rid of the pain.)

As healing has progressed, I have been gradually increasing activity. My normal activity level included walking between 10,000 and 17,000 steps a day on days when I was working. That translates to 5 to 9 miles of walking. Two days ago, I was able to walk a little over a mile. Yesterday, I walked about ¾ miles. Today, I may try to go about 2 miles.

In the best of all medical worlds, I would have gotten an MRI to accurately identify the tissues involved in my injury. Lab tests might have helped to identify some markers of inflammation. I did not have the typical redness and warmth associated with inflammation. Nonetheless, the pattern of spread of the pain suggests that inflammatory chemicals flowed from the initial injured site (gluteus medius muscle) migrating first to the trochanteric area, and then down the iliotibial band. COVID 19 events have made us aware of the concept of a “cytokine storm.” My clinical gut tells me I suffered from a form of a localized cytokine storm. Sad to say, we have the technical ability to understand these issues, but we (in a collective sense) lack the will to devote our resources to get to a deeper understanding of our biological ills.

What Is Pain?

We all experience pain, each with our own unique perspective. But what is pain? Do we really understand it?

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.”

This definition is inadequate.

Traditional Theories of the Neuron

Traditional medical models of the nervous system have their roots in the science of the 1940s and 1950s. The basic tenets of these theories have not changed. Back in those days, there were no transistors, diodes, microchips, LED lights and screens, or circuit boards. Telephones were wired into a central station where an operator made the connection between two parties. The roots of today’s “science” of the nervous system, and pain as part of that, lie in this conceptual framework.

Over the years, computers have become much smaller. As a graduate student at Cornell, I used a computer that took up the first floor of an enormous building. Now, a handheld smartphone has far more computing and storage power. However, concepts in neuroscience remain unchanged, still using concepts from the 1950s.

In traditional models of neuroscience, chemicals transmit electrical signals from one nerve to another.

An electric current reaches the end of a nerve fiber. That nerve fiber releases a chemical. It migrates to attaches to a receptor in a second nerve. The receptor, with the chemical attached, somehow triggers an electrical signal to move along the second nerve.

The electrical currents develop as sodium ions flow into the nerve fiber, and potassium flow out. A sodium pump expels the sodium ions. This ionic dance sends a net positive electrical charge flowing down the nerve fiber. The problem is simple: no one has ever identified the sodium pump. Without that pump, the ion theory will not work.

In the current theory, a chemical transmitter, like glutamate or GABA or some other chemical, is presumably released by one neuron. It floats over to connect with a receptor in the second neuron. The merge triggers the second neuron to propagate a new nerve signal.

Ion Power is a Bull Moose! The Nervous System is Far More Intricate.

Can anyone really conceive of a chemical and ions flowing inside your smartphone? Can you point to any device in the world that uses chemical signaling to accomplish complex signaling? I can’t.

Batteries use chemical reactions to produce electrical currents. Some batteries are rechargeable. Batteries are everywhere, in many of our devices. They are in cars and computers. But have you ever seen a battery in a living person? (People with implanted pacemakers and pumps do not count.)

Ion Thrust engines in rockets steer and guide them in space. They use electrical power to create ionic forms of gases and then propel these ions to move. They then move the rocket, a reaction to the momentum imparted from the ionic gas to the rocket. But those do not work on earth.

A group of engineers at MIT made a model airplane powered by the flow of ionic form of Nitrogen in the air around the plane. It is a fascinating design. But it uses electricity at 20,000 volts. The human nervous system works at the millivolt level. The voltage needed to fly the airplane would fry any nervous system it came in contact with.

Scientific Falsification of the Chemical Theory of the Neuron

In science, “falsifying” a theory means to prove that the theory is wrong. A more formal refutation, or falsification, of the chemical theory of the neuron is found at www.Neuronresearch.net.

Fulton also presents a detailed falsification of the Hodgkin-Huxley equation, which was the theoretical basis of the chemical theory of the neuron.

I propose that it is time for a new concept of the human nervous system, that is a new paradigm. Details of one such theory are available on Mr. Fulton’s website. He has developed the concept of a biologic transistor that works at synapses to conduct electrical signals.

The New Theory. The 21st Century Neuron.

Mr. Fulton also postulates that the electrical power of the neuron is produced primarily from a chemical reaction. Glutamate is a negatively charged ionic amino acid. At the normal acid levels of the human body, glutamate exists as an ion. Using enzymes near synapses, glutamate (negatively charged) is converted to Gamma Amino Butyric Acid (GABA) which is neutral with no charge. The reaction produces a free electron transported by quantum mechanical means into the interior of the nerve process. In this way, conversion of glutamate to GABA serves as the battery to give the nervous system its electrical power. Fulton also details the electronics of signal production, signal transmission, and signal manipulation that uses 21st century electronic concepts. His theory does not depend on ion channels, or ion pumps, etc.

With this electronic theory, it would be possible to understand the human nervous system as an analog computer.

That brings me back to pain in its various forms and intensities. In traditional medicine, pain is thought to result from chemically generated and transmitted signals from the site of injury to the brain.

Pain Defined in the 21st Century

I would propose that pain is in fact an electronically mediated alarm system. In this model, the brain receives innumerable signals to tell it all is well and functioning normally. In the normal state the brain is directing attention to the exterior world, using sensations of vision, hearing and touch and pressure. Unlike these sensations, pain arises entirely from internal sensors or processes. Think of the brain as the cockpit of a normally functioning airplane. When all is well, the only sound is from the rush of air around the fuselage. But if something goes wrong, a sensor will send a signal to set off an alarm in the cockpit.

Similarly, when something goes wrong inside the body, the sensors (and there are many of them) send an array of signals to the brain. They rarely localize the problem. Their purpose is simple: to alert us that something is wrong, and the brain needs to divert its attention to the problem area.

Pain then is a conscious awareness that something is wrong. It is generated because the brain senses an array of incoming signals with a pattern different from the normal array of signals it receives.

With this definition of pain, it is possible to see the various pains that our members describe as the result of a common electronic signaling system. The nature of the electronic signals are different, varying in perhaps voltage of the signal generated, the type of neuron involved, or the frequency. But the basic process is the same: “Pain” is the brain’s conscious awareness that all is not well. We still have the experience of pain, but the process that leads to that experience can begin to make sense.

Using the concept of pain as a conscious awareness of sensation that differs from normal, we can also begin a new understanding of chronic pain. The CDC estimates that 10,000,000 Americans have High Impact Chronic Pain. That is pain that significantly interferes with normal activity.

Don’t Worry if You Do Not Understand!

I hope these complex concepts make some sense. The theories need further development and integration with observed science. Leave a comment if you have questions. I admit in advance that I do not understand all the nuances of this theory of the neuron. However, the basic tenets make sense to me at a gut level. Some people would find this nauseating, but my technically trained gut thrives on new information like this.

Fulton’s theories are a work in process. It is not a completed work. There is much work that is needed to develop an understanding of how our sensory and neuromuscular systems interact. We need a community of people with a good understanding of a variety of different fields. These include electrical engineering, molecular science including chemistry and biology, and medical science. Such a community can bring novel concepts to life. I welcome any feedback and sharing of this information with anyone who might be interested. I hope for some real illumination of 21st Century concepts of neural science.

I believe that Fulton’s theories provide a concrete explanation for the fatigue that often accompanies Fibromyalgia, and my next story will talk about that.