Pain Researcher Lorimer Moseley: Pain is an Emergent Experience
This is an excerpt from the transcript of Lorimer Moseley’s Pain video.
Continuing with his description of pain, Lorimer tells us…
Pain is the output. Nociception is one of the inputs.
All of the inputs are evaluated when we’re talking about pain, I think, according to this question: How dangerous is this? Based on everything I know, which is all of the information available to me right now, how dangerous is this really?
Let’s talk about a clinician’s low back patient walking past your desk that has a few vertebrae and plastic discs sitting on it. I think this visual information will be processed because it’s relevant to the back, according to the question “how dangerous is this now.” I would argue it has just become slightly more dangerous because of that visual input—just a little bit.
We have to remember that nociception refers to activity in the nerves that operate the system—the danger messenger system, if you like. We call this the nociceptive system—the C, A-deltas and their projections in the spinal cord. Those projections go to many different parts of the brain. They have a serious stopover at the thalamus, but they go to other parts as well. The thalamus projects up into the brain.
Pain, however, is an emergent experience. It emerges from the human. The language I use is that pain emerges from the brain. That’s not actually correct, because if you took a brain and put it on a pillow, pain can’t happen, right?
This might seem stupid, but I have been criticized—by people I respect—as being neuroeccentric, because the brain itself can’t make pain. It’s the human.
However, for the sake of the argument, it’s a lot easier in dealing with patients and in normal conversation to say pain is an emergent property of the brain…remembering the caveat behind it.
That experience—that emergent conscious experience—serves to evoke a behavioral protective response. It makes us do something. Nociception does not make us do anything. It can be enough to cause reflexive withdrawals, but it does not make us voluntarily do anything.
No patient will come in and say, “I have a bit of A-delta fiber firing going on in my thigh. Could you reduce it, please?” Why is it that we interpret when they come in and say, “I have pain in my thigh,” we hear, “I have nociceptive activity.” Certainly, we encompass that. It’s a very clear modulator, but it’s not the only one.
There’s no such thing as a pain stimulus. Nothing has the property of pain. It’s an emergent property of the human.
Pain receptor—there’s no such thing.
Pain pathway—there’s no such thing.
Descending pain control—there’s no such thing as that.
There are, however, noxious stimuli nociceptors, nociceptive pathways and descending nociceptive control. Anti-nociception turns the nociception down. Pro-nociception turns the nociception up.
It’s very tempting to use these words, and most of the time it doesn’t really matter. It’s just semantics.
But every day clinicians have patients for whom it’s more than semantics when they make that mistake.
Click here to watch more of Lorimer’s discussion of pain, including several great preview clips from his Pain video.
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