Adapting to Chronic Pain Conditions

[gerry the neck]

Adapting to Chronic Pain.
How to get the best from a Chronic Pain Mindset.

First, what is a chronic pain mindset ? I like to think of it as this….a person is involved in a motor accident. They wake up in hospital next day, and discover that an arm has been amputated. It’s a watershed moment. Huge disappointment coupled with a depressing expectation of an unpredictable future, nevermind the pain etc. It may well take that person several months, even years, to come to terms with such a life changing event. However, with a little luck, the pain should ease off, and , from that point onwards, discounting any phantom pain events, options for adapting back to a purposeful life can be explored.

That’s an acute injury, with lasting effects, and adaptability options. Chronic Pain conditions, with little or no remedial prospects, are similar to that scenario, except the injury and the watershed moment are, in theory, recurring on a daily basis, but to a lesser degree, and there is usually little prospect of being able to subjectively envisage an eventual pain-free self management outcome. If the calculated risks and potential outcomes can be predicted fairly accurately, as they would be with the amputated arm scenario, then the planning for the future becomes less unpredictable, and more positive. Chronic pain patients usually can’t predict even tomorrow’s pain intensity, and so they must adjust their expectations to accommodate the unpredictable….that’s like allowing a little (or large) vacuum into any planning, or expectations, so that, if the worst happens, there’s always room to maneuver or change yesterday’s expectations/plans. Not easy, when you consider the expectations of how social/work pressures demand a co-ordination between people so that time is not wasted……it’s okay to lapse occasionally with an excuse, but not on a regular basis. So, it’s a double whammy for the chronic pain patient. They must face the daily disappointment of negative pain improvement, coupled with a struggle to meet social/work expectations. That’s something which can only go wrong, without good management.

There’s also the small matter of ‘healing expectations’ which we all rely on to reinforce our belief that we can cope with whatever life presents us with. The ‘healing expectation’, although we may not be aware of how it dominates all our thinking, is a major foundation of all our decision making. Without it, we would be living in fear of unpredicted health issues, and would probably find it difficult to leave the house without a dominating fear of being injured, or catching an infection, which might result in death. It is only our ‘trust’ in healing expectations which keeps such a mindset from dominating our every action. This, however, is what chronic pain patients, to a lesser extent, must deal with on a daily basis. Although they understand that their ‘healing expectations’ are still valid for everyday threats, they are also more than aware that there are no ‘healing expectations’ for their chronic condition….and so the negative protective mindset appears, and it must somehow mesh with the ‘healing expectations’ mindset, and still make sense. Again, not an easy psychological balancing act to achieve. Chronic patients juggle these conflicting conscious understandings continually, something which is probably not too obvious to those who assess patients for treatments. Where there are conflicting internal understandings of foundational platforms which we build our lives upon, it is likely that either one understanding, or the other, will dominate at any given time. But it doesn’t mean that either understanding is dispensed with. It’s an awkward duality of understandings, which can undermine the platform with continual contradictions…but, it can be managed.

Added to these, within the chronic mindset, there is also the direct effects of the painful sensations. These effects are no different to acute pain events, except they occur continuously, whether fluctuating, intermittent, constant, or variable in intensity. Makes no difference, they are just like acute events recurring daily, with little prospect of alleviation, and no prospect of matching normal ‘healing expectations’. The cause of the pain may be neurological or physiological, but it is unlikely to be psychological. We wouldn’t insist to a patient who’s just had their arm amputated that their perceived pain is merely psychological….and so we shouldn’t to a chronic pain patient where the cause is less evident. The problem there is ignorance, not the patient’s psychological state. Medication is obviously a big issue where pain is concerned, but I prefer to look at and assess the probables/possibles without that complication. The first goal has to be treatment without possible side-effects. Chronic patients learn, over time, to be resilient to pain, perhaps more so than non-chronic patients….it’s difficult to accurately assess toleration levels in both groups. So, I’m inclined towards thinking that the other mindset issues mentioned above have a more profound effect on the chronic mindset than just the recurring pain sensations. To put it another way, if the pain sensations are eased with medications, the other issues will still dominate the mindset….a chronic patient will not escape the default thinking which evolves from dealing with a recurring issue.

So, that’s the mindset. Next question is how to get the best from it ? The chronic mindset and the ‘healing expectation’ mindset do not mesh together well. Any comparisons, or comparative expectations, are somewhat pointless. The chronic patient must find some satisfaction or contentment within the ‘no expected healing’ mindset, in order to manage their lives. They can’t be expected to strive for a ‘healing expectation’ result, when all the evidence suggests it can never be achieved. That’s just adding to their already ample frustrations. So, what achievable goals can be introduced into their management systems, which can be better satisfied. This is where ‘comfort zones’ become important. Comfort zones create a good environment for good decision making, and good decision making is exactly what’s required for deciding good management strategies. Comfort zones can really only be determined subjectively, but the means to discovering them can be advised. Sometimes the distress of the patient interferes with their decision making, the advice to exercise etc. can be counter-productive and confusing, especially when the exercises don’t work, and a little coaxing (neuro nudging) towards first establishing a ‘comfort zone’ before any decisions, can be really helpful. Once settled, the patient can then start working on their own ideas for expanding the comfort zone, and perhaps be able to make more rational decisions about any suggested treatments. Empowering the chronic patient into a sense of control over their own comfort zones will open the door to more exploratory self management.

I think that it’s probably important to realise that a chronic pain patient will be unable to alter their default mindset to accommodate an approach which doesn’t include an understanding of the complex conflictual ‘healing expectation’ mindset which already exists. The reality of that internal conflict can’t be denied, and yet they are encouraged to attempt such an alteration in most attempted treatments. That’s merely imposing the expectations of the operator onto an already confused patient. The operator should be prepared, and trained, to accept the chronic mindset first, before assuming whether the patient is willing to participate in treatments, or not. That’s what empowering the patient really means.

In conclusion, the best mindset available to a chronic pain patient is probably one where there is no demanded, or suggested, imposition of expectations which may not be achievable. Such impositions, although possibly well intended, are more likely to increase ‘no healing expectations’, and mindset conflict dilemmas , rather than help settle those persistent perceptions which the chronic patient has no choice but to accept as their default mindset. The way to settle that daily continuous internal conflict is to offer advise which helps the patient to focus on ‘comfort zones’ , which in turn offers up better options for the patient to explore expanding those zones. As a first step, that’s an achievable goal which won’t conflict with already embedded mindset dilemmas. Also, it will help the patient to realise the importance of their own primary role in exploring favourable options, rather than an over-reliance on advised strategies, which might be unintentionally overlooking the complex dilemmas in play. Basically, any attempts to return the patient to a more normal appreciation of ‘healing expectations’, by means of suggestion or imposed regimes which don’t consider the chronic mindset, are doomed to failure. That mindset has evolved from the realities experienced, and it won’t be changed by suggestion or imposed regimes, unless those suggestions and regimes can prove, without doubt, that they can resolve the issues which created the mindset in the first place. The chronic mindset is a valid mindset, and should be respected by all, as such.

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[gerry the neck]

Again with the 'Chronic Mindset' , or 'How to re-introduce a sense of purpose into a 'Chronic Mindset' '.


It seems there are two competing 'mindsets' which default themselves into our consciousness, and are defined by their appropriateness to any given physical condition. One is the 'normal' mindset, which has a foundation of healing expectation, and it imbues us with a 'fighting spirit' to help overcome the negativities encountered in any healing process. The other is the 'chronic' mindset, which endures a constant daily battering of those 'normal' healing expectations, to the point where, instead of a stabilisation of any negative perceptions, those same perceptions can become negatively exaggerated. The purpose of this post is to explore the 'chronic' mindset which seems to allow for that change from contained negativity into self-exaggerating negativity.

Anyone with a chronic painful condition will encounter this mindset switching on a daily basis. The 'normal' default healing expectation mindset will be challenged constantly, and once it has been questioned internally, and its inappropriateness for a chronic condition established in the patients mind, there had better be a suitable replacement mindset available to enable the patient to metaphorically pick up the pieces and create a new sense of purpose for the management of their condition. Otherwise their foundational default mindset will lack structure, and they will inevitably open a psychological door to invading negative overviews. This result is more common with conditions which cannot, as yet, be explained well to any satisfaction, or with conditions whose behaviour doesn't always reflect the officially stated description....and perhaps, particularly with chronic neurological conditions which tend to display by means of referred, radiated, or even seemingly displaced symptoms.

There is something to be said, here, for how a good informed description of a condition can have a positive placebo effect on the chronic mindset, if only because the patient senses an empathy with their struggle to first understand their condition, before considering management techniques.

So, once the 'normal' default healing expectation mindset has been relentlessly undermined by constant daily questioning of its appropriateness, the question arises....'What is left to enable a chronic patient to rebuild an alternative mindset which accomodates the real future difficulties they are likely to be faced with ?'. And, of course, 'Will this new mindset help restore a 'fighting spirit' for contending with future, as yet unknown, negativities ?'. Any alternative adopted mindset must be self-convincing, almost in the same way that 'normal' healing expectation mindsets are assumed sub-consciously, rather than imposed consciously......a patient's struggle to adopt a new mindset should be seen as a positive effort to manage their condition, and a social acceptance of such endeavours can make that process easier than it might otherwise be. A continued insistence that the patient shouldn't give up on their normal healing expectation mindset can create a conflict for the patient, as it often does, and this is an area where the professional / operator, who maybe hasn't any subjective experience of a failure of healing expectation mindsets, needs to be sensitive to the internal struggle of the chronic patient.

The chronic patient must explore new rules for self-management, because the old reliable rules which come with healing expectation mindsets are no longer applicable to the chronic condition.....although they are still relevant for other non-chronic issues which might arise. And so, the chronic patient must continually switch mindsets to deal with both normal healing expectation, and chronic no-healing expectation.....but, hopefully, not at the expense of either mindset being artificially forced to exclude the other.

[gerry the neck]

'Lost in Translation'




I don't think it's unfair to assume that most patients with chronic pain conditions are being treated
by operators who have never had the chronic pain experience. It's probably also not unfair to suggest
that most operators, not having had the subjective chronic experience, are only capable of imagining,
within the expanse of their own experiences, the entire complexity of a chronic pain experience. Taking
that notion a little further I might also suggest that, where the chronic event might have a 'hidden' nature,
as many do, with little apparent evidence of 'cause and effect', then the operator's imagining of the
condition becomes particularly vulnerable to misinterpretation, even to the point of a questioning of the
patients narrative.


We all, even those with chronic conditions, have a default mindset, which resists perceiving 'negative'
outcomes, especially where cause and effect are not so evident. This is a survival mechanism which restricts
us from assuming that any remedial actions might be pointless, and re-encourages us to always attempt to
correct whatever seems to be malfunctioning. It is a 'healing expectation' mindset, common to both operator
and patient. However, where a chronic condition has convinced a patient to expect less from this 'healing
expectation', they might easily find themselves at odds with an operator whose default mindset still insists
that 'healing expectations' should not be sacrificed on the road to managing the chronic condition. Put
another way.....with little evidence of cause and effect for the chronicity, the operator is prone to
assuming that the patient may be contributing to the chronicity, merely by seemingly abandoning their
'healing expectation' mindset. Much current pain theory seems to focus on this operator/patient disjoint,
and the theory then tends towards a questioning of the patient narrative as a contributory factor in the
continuance of chronic pain.


This is a mistaken perception on the part of the operators. Really, the only vulnerable variable in
that operator/patient equation, is the operator's lack of subjective experience, and their attempted
'imagining' of the patient's narrative, which doesn't seem to resonate with their own experience, and
actually conflicts with their own default 'healing expectation' mindset. What usually ends up happening
is an attempted disavowing of the patient's narrative, which includes a possible undermining of the
patient's intuitive understandings, in an attempt to steer the patient on to a course which the operator
feels more comfortable with.


The subsequent 'lost' patient narrative becomes, by default, the greatest loss for hopes to improvements
in treatments. Bearing in mind, for the purposes of this post, I'm only focussing on where some
approaches to treatment may be straying from a patient narrative empathy, into areas which seemingly
only satisfy the operator's own difficulties with imagining a 'no healing expectation' mindset. The
patient narrative, ethically, must always be the driving force behind any attempted treatments.

[gerry the neck]

Chronic Pain........Reasoning and Adapting.




There are a number of chronic pain conditions, particularly neurological conditions, which don't offer a reasonable 'cause and effect' explanation naturally, to those who experience them. Mostly, they are 'hidden' conditions, and the suspected cause is usually some unknown, threat to, or impingement upon, the nerve structure, and usually in the spinal area. Perhaps, most common is some vulnerability in the neck area, giving rise to a variety of radiated, or referred, painful distressing symptoms, whether intermittent, fluctuating in intensity, regular, or ever-changing, but always 'chronic' by virtue of the likleyhood of repetition over an extended time span which would not be expected from a more acute condition. Currently, there are also an equal variety of explanations given for these 'hidden source' symptoms which, when combined with an already confusing array of actual symptoms, can only add to the overall confused nature and explanation of the experience.


Perhaps the first step towards achieving a sense of control over any physical condition, is the need to satisfy the reasoning behind why such a condition, or why such symptoms, might exist in the first place. Without some convincing understanding of that platform, any actions taken to remedy or alleviate the symptoms will inevitably lack the kind of sense of purpose which is required to tackle any problem head-on. There must be a 'real' sense of purpose, and there must be some 'real' reasoning to support it. If a patient detects any confusion, or 'unknowing', in the professionals assessments / advice, they will inevitably lessen their required commitment to any suggested treatments. Unfortunately, this gap in the reasoning behind suggested treatments is usually filled with ever-increasing pain relieving medications, which, besides maybe offering temporary relief, really only increase the options for ignoring any attempt to rationalise the problem in a more reasonable way.


Where uncertainty exists, any patient with a 'hidden' condition, will eventually attempt to assume some reasoning on to their predicament, whether right or wrong, usually dependent on their acquired knowledge of their possible condition.....whatever the source. Simply guiding that 'patient reasoning' into as-near-as-possible the right place, may well be the best possible treatment under the circumstances, before taking any 'statistically unproven' treatments into consideration. Unfotunately, most current treatments for these 'hidden' conditions are best-considered 'safe' options, rather than proven remedies. Such is the state of the science at the moment, and the ethics demand a containment of exploratory approaches. To get around this 'stuck in aspic' approach, I'd suggest that merely refining the reasoning behind the explanations for any 'hidden' condition can open doors for the patient to self-explore the issues, based on a foundational rationalisation of most probable causes and effects. Because there is usually an inherent confusion at play, both with operator and with patient, there is also usually a tendency to drift towards medications and other less reasoned options. A sense of control can really only be inspired by means of a solid reasoned platform....offer this to patients, and perhaps they will, in turn, inspire currently restrained treatments to drift towards less considered options with better remedial potential.


Improvements are really only validated by their relevance to patient experience. Perhaps I would also add here that 'knowing' the causes and effects of any problem usually amounts to half the battle in the struggle to contain and control that problem. Also, building treatment strategies based on that reasoned knowledge, usually amounts to taking care of the other half of the battle. Any confusion entering that equation usually amounts to a lessening of determined effort to find solutions. This clarity of understanding really needs to be enhanced before expecting any patient with a 'hidden condition' to respond with any real commitment. And if 'neuro-nudging' is to be believed, then it's probably best that the patient believes they have arrived at a reasoned understanding themselves, despite being nudged there by the craft of the operator ! The reasoning must be self-convincing, perhaps even subliminally self-convincing, before a patient will assume the full challenge of exploratory self-management.

[gerry the neck]

Mindset Dissonance


It might seem like a peculiar thing to say, but I have come to a certain understanding that anyone who hasn't themselves experienced a painful chronic condition might have real difficulty in gaining an understanding of what living with chronic pain is really like, and how the two mindsets differ. So, what we tend to get, by way of support services, is a population of chronic pain sufferers being treated by operators who don't fully understand the 24/7 realities, and the enforced 'lifestyle' alterations that a chronic condition demands by default. Those differences, in both default mindsets, are called 'Dissonances', perhaps because their natural frequencies not only differ, but are competitive because of their differences, and assumptions are imposed, backwards and forwards, in order to accomodate the dissonances, rather than to accomodate the realities.

The same can be said, perhaps, about the difficulties experienced when those in chronic pain communicate with each other. We all seem to have this psychological defense mechanism which kicks in when we feel our 'trust' in our own healing abilities is being challenged by having to accept that some issues don't heal....call it 'Survival of the Most Positive' for want of a better description. And, I'm sure that anyone who hasn't had a chronic pain condition, but who is continually treating those who have, must develop even more resilient ways of not letting the 'no healing expectation' mindset affect them....nobody functions well when swamped with negativities. It's only natural to want to preserve a positive outlook....but that might come at the expense of better understanding. I think the recent introduction of the term 'persistent' to replace the term 'chronic' is an obvious indication of this tendency....and, in my opinion, it is wrong because it comes with a metaphorical context which most likely doesn't fit the required description, and could possibly lead to a perceived lesser need for appropriate treatments. That's another issue that doesn't deserve overlooking.

Anyway, back to the differing mindsets. I don't think that it's unfair to say that, with some chronic conditions, patients will feel that treatments don't take into account their 24/7 struggles, nor their default mindsets which can only see more trouble ahead. Perhaps they can sense that their operators might not share a similar outlook, and therefore some mistrust enters the operator / patient encounter. Maybe ! How to ease that dissonance, so both parties can share their views equally, is probably the best that can be achieved, initially, for introducing some confidence into the treatments. No Confidence = No Placebo Effect, and , on the understanding that the patient is limited by their ongoing distress, and the operator is supposedly trained to rise above their own mindset defaults, then the onus has to be on the operator to seek ways to negate the perceived dissonances. In other words, the operator should be prepared to ignore their own mindset defaults when offering treatment to patients whose mindsets differ.

BTW, this is a 'mindset crossover' observation, rather than a criticism of the good intentions of operators....although it might seem as such. Always best to thread carefully on previously littered broken glass !

[gerry the neck]

So, what is ‘Pain’ , exactly ?

It’s really quite remarkable that we don’t as yet have a clearly organised definition of the pain event. There are many theories, from Cartesian to emergent, but, perhaps not too unstrangely, these theories seem to remain unchallenged within the small pockets of thinking fraternities which created them. There is an obvious lack of resonance between the theories and the subjective narrative of pain experience. Currently, the most aggressive theories suggest that pain is a psychological ‘emergent’ perception, which doesn’t require a direct link, nor correlation, to an actual threat of injury or disease. In other words, the ‘emergent’ perceptions can instigate themselves, and perpetuate themselves, with no known recognisable cause, and with no known predictive certainty about perpetuity. I am inclined to dispute such an overview because it would seem to relegate pain perceptions into relative insignificance when assessing any patient....’if the pain perceptions have no known origin, and if their fluctuations depend upon patient mindset variations, then there is obviously no pressing requirement for any interference other than attempting to alter a patient’s mindset ’ ! And so, I must ask again....’What is pain, exactly ?’, because I have an intuitive sense that conflicts with that theorised approach.

So, what is the most obvious attribute of a pain event/perception/sensation, besides the more obvious discomfort it causes ? For me, top of the list has to be the manner by which our normally clear and responsive thinking seems to lose its clarity. A confusion is imposed on conscious thought, which highlights the distress, but discourages reaction which might be inappropriate. This may well be the ‘purpose’ of the pain perception, especially if we consider that a hasty reaction might further threaten an already vulnerable situation. If we think of a ‘purposefully’ created pain perception, perhaps originating in the autonomic protective systems, and then manifested in the conscious mind, as a means of restraining conscious reactions, it would seem to tick a lot of boxes about pain perceptions which aren’t normally considered. Generally, we only tend to see pain perceptions as threat warnings, or as signals requiring reactions. So, if we tinker with our overview a little, it’s not too difficult to come up with an almost opposite explanation i.e. that pain is meant to restrain reactions. I don’t think there could be much of an argument against the possible beneficial effects of a restraining ‘purpose’ , thus feeding into the overview perception of pain being a ‘for the good’ essential tool of the autonomic protective systems. We already know that our autonomic systems, the nervous system and the immune system, operate for our benefit, almost perfectly, and without any conscious control or interference, so why not assume that pain perceptions are an integral feature of that same protectively organised structure.

My own understanding of pain perceptions, intuitively observed, incline me towards seeing pain perceptions as some ‘crossover’ event, where, because consciousness requires perceptions to function, and where we have no conscious perceptions of nervous system/immune system operations, there has somehow evolved a need for a restraining element to discourage any inappropriate reactions. Seeing pain perceptions in that light, I think it gives a ‘purpose’ to the pain event which can be rationalised, and would have a beneficial effect on the way patients currently understand and respond to their pain experiences. On the other hand, if we define pain as a variable event, lacking any particular purpose, are we not really just assuming that pain treatments might be irrelevant to the bigger picture of treating recognisable threats. For instance, with neurological painful conditions, where no obvious source has been detected, are we to assume that the patient’s pain narrative should be ignored as ‘possibly consciously invented’ ? The ethics involved in such assumptions flag themselves up automatically, and should be a pointer to re-thinking the entire ‘pain question’.

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[gerry the neck]

‘Chronic’ v ‘Persistent’

I’m just going to freewheel on this issue. I have to admit that I am totally baffled by the recent trend to replace the ‘chronic’ reference with the totally inappropriate ‘persistent’ reference. This trend has now seemingly penetrated into the inner circles of the Neuro specialists who are concerned with the pain theory and possible treatments of chronic pain conditions. It concerns me that incorrectly premised thinking will achieve nothing, and may even lead to inappropriate treatments evolving from basic misunderstandings. ‘Persistent’ means one thing....that an issue has continued after a known resolution point has been passed. To assume that meaning onto a ‘chronic’ issue, which means that an issue will continue over time with no known resolution point, is nothing less than an attempt to soften the ‘chronic’ undertones by supplanting them with a meaningless replacement description. So, I have to ask, what might have inspired this desire to impose an inappropriate descriptive reference (persistent) onto an already perfectly described condition (chronic).

Excuse my scepticism here, but perhaps it was a means for operators to not be too concerned with their failures in the treatment of chronic conditions. As such, it might have relevance as an operator’s placebo. Maybe it is considered that ‘persistent’ has less negative connotations in the chronic patient mindset, but that doesn’t excuse an unrequired complete change of meaning. Maybe there are those who don’t understand the continuance of chronic conditions, and they have to assume a resolution point somewhere in the process to validate their interactions. None of these possible reasons for an insistence on ‘persistence’ to replace ‘chronic’ has any relevance whatsoever on the subjective ‘chronic’ experience....which remains ‘chronic’ regardless. So what’s the problem here ? Patients do not have a problem with their condition being referred to as ‘chronic’.....so why the need for changing that to something which simply doesn’t make any sense to the patient. Chronic conditions are called ‘chronic’ because there is no known possible resolution over time. Is there really a need to confuse that issue ? A chronic patient is entitled to receive treatment for their presented condition, rather than treatment for some imaginary condition which has seemingly passed its expected resolution point.

Let’s be clear about this. Any operators assuming that a chronic condition is really a persistent condition, may well be operating off a false premise. That has ethical implications which might mean inappropriate treatments for chronic patients. That is what’s at stake when the reality and meaning of a medical condition have an unsuitable meaning imposed on them for the convenience of operators. And it must be challenged vigorously, before it insidiously becomes the norm and affects future advances in treatments. As a chronic patient myself (cervical spondylosis) I find it meaningless to have my condition referred to as ‘persistent’. I know my condition is chronic, it’s degenerative, and I have no problem perceiving it as such. It would further bother me if I had to perceive it as something which should have resolved, but has somehow ‘persisted’ without explanation.

So, let’s stick with the definitions which make sense, no matter how difficult it is to accept a ‘chronic’ overview. At least patients will understand that their condition is understood when presenting for treatments.

[gerry the neck]

Sleep and Pain

So, why is it that we tend not to feel, or experience, pain whilst we sleep ? Most chronic pain patients would probably attest to that ‘cottonwool’ cosy pain-easing sensation they experience as they start to fall asleep. They might also attest to a similar reversal of those sensations as they wake. The clarity of any pains / discomforts seems to increase relative to a graded increasing of conscious awareness. This process may only take seconds, under normal circumstances, but can take much longer with more serious pain issues. There would seem to be a direct relationship between the clarifying perception of the pain, and the gradual clarifying of post-sleep awareness....which seems to suggest that pain perceptions only exist in our awareness. If consciousness is required before a manifestation of pain can be recognised, then we need to ask a question about what conditions of consciousness are required to allow pain perceptions to initially be noticed.
So, what happens when we sleep ? This may be argued about, but I’d suggest there are no pain sensations when asleep. If there is disturbed, or intermittent, sleep, there can be a sense of being woken by the pain, but I’d contend that that was never a proper sleep in the first place. Let’s assume, for argument sake, that there is no pain felt whilst properly asleep....and I’ll assume that such is the consistent global experience. It would seem that any pain, whilst conscious, eases whilst falling asleep, and gradually reappears on wakening. It’s impossible to say that pain still carries on in the non-conscious state, because it’s simply impossible to validate in any sense.
That leads to an obvious question.....’Is there any requirement for a pain perception in the sleep state, and if not, why not ?’. Just say, for instance, if we experienced pain perceptions right through our sleep, what possible purpose would that serve ? I can’t think of a single possible purpose. So, if there’s no requirement for pain perceptions whilst we sleep, what does that tell us about such a requirement being seemingly essential to our conscious state. One would think that an ongoing injury, or threat , would create a continual responsive reaction regardless of our sleep/conscious state. We already know that our autonomic nervous system and immune system carry on operating regardless of whether we are conscious or not....some, I’m sure, would say that the autonomic systems seem to work better when we sleep, making rest a good healer. So, why does the pain perception, so-called, ‘continual’ warning system, have its functioning interrupted.
That should bring us back to the ‘conscious requirement for pain’ question. If the effects of a pain perception are only relevant to a requirement for a residual effect in consciousness , for example...a need to restrain any inappropriate conscious reactions to an injury (putting dirt on a wound for instance) , then the usefulness of a pain perception would be obvious. Also, it would help explain why there is seemingly no requirement for pain perceptions whilst asleep, because consciousness can’t react whilst asleep....thus negating the need for restraint.

And so, what is it about sleep that there may be no requirement for ongoing ‘protective’ perceptions. Of course, a new injury whilst asleep, will wake us up with a gradual realisation of pain.....and that assumes all the characteristics of conscious injury, once awake. But even someone with a broken finger will inevitably fall into pain-free sleep eventually. I’m inclined towards thinking that the sleep state is the optimal state for adaptive corrective processes instigated by the nervous and immune systems. Neither of these autonomic systems requires conscious decision making, and they seem to operate regardless of whether conscious or asleep (or unconscious, or non-conscious for that matter). In fact, it might be suggested that the autonomic systems can be hindered by conscious reactions when we’re awake, and there has evolved a requirement for some means of containing possible conscious reactions. That might seem like a very appropriate role for pain perceptions.

There’s also the tricky question of whether we are consciously capable of unravelling the inner secrets of pain perceptions, and of consciousness for that matter, because in doing so we might consciously compromise the entire protective system. If consciousness is perceived as being a potential threat to our autonomic protective systems, then it would make sense that, if consciousness evolved after the autonomic systems, as a secondary ‘externalised’ threat detection/reaction system, which it may well have done, it may well come with an inherent failsafe inability to define itself.....lest it should itself become a threat to the core autonomic protectors. That, I know, is stretching at the seams somewhat, but it might also help to explain our continued struggle to define consciousness to our conscious satisfaction. We are now capable of witnessing these complex protective behaviours on a molecular level, so why not assume that the same rules apply to everything. The more we learn about viral ability to self-disguise, invade and even mutate our protective anti-viral defences, the more we should become aware of the possible complex protections already in place to govern interactions between consciousness and autonomic systems.

- - - Updated - - -

Here’s a little puzzle for any aspiring pain theorist to chew over.......

Our entire history of medical interventions, going back to whenever, has been one of massive failure, of inappropriate interventions, only recently in the last 150 years or so, improving to high standards as we know them today. Excepting recent advances, our interventions have been mostly ‘threatening’ in nature.......something that probably didn’t go unnoticed by our protective autonomic systems, which always seemed to maintain a high standard of resistence to threats.

Would it be rational to assume, on the basis of that overview, that our ‘conscious’ interventions have been one of the greater threats to our ‘life ensuring’ autonomic protective systems ? Considering that, even today, many medical interventions would be deemed too risky to contemplate, without our learned knowledge of autonomic healing responses.....is it not rational to assume that ‘consciousness’, itself, might register with the autonomic systems as a threat ? If that’s a conceivable possibility, then it is probably more than likely that the autonomic systems have evolved a defensive response, just like they would with any external or internal threat. And, could that response manifest as an instigation of a conscious pain perception, perhaps as a means of restraining inappropriate conscious reactions to threats already being responded to by the autonomic systems.

The problem, with consciously defining pain perceptions, may lie in our tendency to always perceive our consciousness, and our protective systems, acting as ‘one’, and therefore it would seem contradictory to ever perceive them as competing against each other. I think it’s fine for us, with our perceptive limitations, to conceptualize consciousness as a ‘threat detection and response system’ , operating against external threats detected by sensory stimuli. But, when it comes to the protective healing abilities of the autonomic responses, consciousness would really only seem to have an ‘external agent’ role to play. It appears ‘secondary’, by comparison, and, because of its obvious questionable integrity in terms of its ‘decided’ responses, it too must be protected against..

Is that inconceivable, as an assumed overview to guide our thinking on the pain question ? If it were to be considered conceivable, I think it would have interesting implications for how we treat pain generally, particularly in terms of how patients perceive pain issues. Pain might well be perceived as a benefactory event, specifically intended to restrain conscious reactions to any threat. If we’re discussing mindset adaptations which affect pain experience, then I think the supporting reasoning has to be absolutely convincing, even perhaps, intuitively convincing, for patients to actually feel the possible benefits. Anecdotal suggestions might seem to have a positive influence on a transitory level, perhaps particularly where adaptive healing might already be a possibility, but if its default chronic mindsets we’re hoping to influence, then I think the underlying reasoning must stand up for itself.

[gerry the neck]

Just some thoughts on the ‘frameworks’ we employ when we attempt to define pain.
When we try to consciously rationalise the threat detection nervous and immune systems, we can’t help but be in awe of the almost perfect functionalities involved. Both systems seem to fulfil a role in maintaining the living status of the body organism, perhaps to the point where they are both obvious candidates to sit on top the protective hierarchy of defence mechanisms which the body employs. However, there is one protective function which seems beyond the capabilities of both systems….and that is the detection of, and protection against, external threats which have not yet been actualised on the body. There would seem to be a need for another ‘intelligent’ protective system to fulfil that role.
Thus, perhaps, has consciousness evolved from the autonomic systems, as a means of detecting and responding to external threats before they have been actualised on the body. As such, consciousness might seem to be a ‘secondary’ autonomic system, but its autonomic (instinctive) responses are configured to deal with threat configurations which exist outside the body. Consciousness must have a capacity, a risk vulnerable capacity, to engage with external threats in a manner which would be too compromising or too risky for our primary autonomic systems. So, consciousness may well be a protective ‘buffer zone’ against unactualised external threats.
Because of its possible compromised vulnerability, consciousness might well sit below the primary autonomic systems in the hierarchical protective structure. There would need to be a means for ‘crossover’ exchange of information between the systems, which doesn’t compromise the primary system functionality in any way. The conscious perception we know as ‘pain’ may well be one type of ‘crossover’ event….perhaps informing consciousness of the actualisation of a threatened status, and perhaps, as a ‘reminder’ to consciousness that the primary systems have assumed the main defensive duties. Thus pain might signify a prompted restraint on possible conscious reactions, rather than signify an indication of threat, as it is most commonly perceived. After all, once a threat has been announced, why would there be a need for a continuance of threat warning, once the healing processes have been instigated on an autonomic level.
If all this were so, speculative though it might be, and consciousness were to be a ‘secondary buffer zone’, and pain were to be a ‘system crossover event’, then we might be obliged to perceive consciousness as an intelligent protective system, totally predicated on external threat protection and defence. Considering what we already know about our conscious sensory capabilities, and their obvious prioritised protective functions, I think it is rational to assume such a single purpose for the functionality of consciousness as a whole. Put another way….all conscious thought, including imaginary abstract thought, might well simply be predicated on external threat detection and response purposes.
However, our conscious capabilities to rationalise events are limited, and limited for specific protective reasons. We struggle continuously to rationalise and define consciousness itself, same with the primary autonomic systems, same with the pain event, and same with the non-conscious. What we may be failing to see is that consciousness is ‘restrained’ from rationalising these matters, because doing so would compromise the overall purpose of the protective systems. Consciousness has a vulnerability to external threats, or to becoming a threat itself, and so it is safe-guarded against by means of a separation from the systems which must maintain protective integrity. I think the obvious clue to that separation is the manner in which the primary systems continue to function when consciousness is ‘switched off’…..when asleep, or when unconscious, or even at a young age before we become consciously aware.
As a speculative overview, admittedly in a pretty raw form, this approach to defining consciousness and pain might offer up interesting options for understanding the relationships between separated systems, all functioning in the interests of a protective hierarchy. Our seeming inability to rationalise consciousness and pain as being parts of a comprehensive protective system, might well be a ‘purposeful’ inability to rationalise, predicated on protection against a vulnerability to compromising the purposeful functionalities of our primary protective systems.