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A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 85 More recent neuroscience has modified these ideas, but many are still taught that the body has pain receptors that, once stimulated, send a pain signal to the brain. However, there aren't any actual "pain receptors," so to speak. But, before we get into the finer details of how pain interpretation actually works, let's explore a simple example to see why that idea doesn't pan out. HOW THE BRAIN PRIORITIZES PAIN If you were crossing the street in a quiet neighborhood with no traffic and suddenly sprained your ankle while in the middle of the road, there's a good chance you would feel pain right away and then calmly limp to the side of the road. If, however, you were crossing a very busy street when you sprained your ankle and also noticed a large bus bearing down on you, your reaction would be quite different. Most likely you would sprint to safety on the side of the road first. Only then would you begin to feel pain in your ankle. If there were pain receptors in your ankle, they would send pain signals to the brain immediately in either instance. In the second scenario, the ankle pain may have kept you from focusing on the more important survival task of the moment— getting out of the way of the oncoming bus! We now recognize that pain is far more complex than previously thought. Pain signals do involve sensory receptors connected to nerve fibers that go to the brain. The sensory receptors responsible for sending information about a noxious stimulus, like when you sprain your ankle, are called nociceptors. They are sensitive to chemical, mechanical, and thermal stimuli. But pain isn't felt until the brain receives those signals and interprets the input as pain. This activity happens instantaneously, and it isn't under conscious control. It is helpful to think about pain as an alarm that is generated by our body, just like the alarm system that may be protecting a home. Multiple sensors around the house detect motion or sound and the system determines which ones are minor (like a leaf falling in front of the door) and which ones are important (someone breaking into the house). The alarm signal doesn't go off with every sensor change, only with the ones that are indicative of a potential threat. Just like that alarm system for your house, the nociceptors send many signals to the brain, but the alarm (pain) isn't set off until that information is processed and it is determined that a significant threat exists. Therefore, we now talk about pain being an output of the brain and not a "pain signal" that is coming from the periphery and traveling to the brain. It is very much like the other senses we have. For our hearing, sound waves are captured by the eardrum, but it is not conceived of as a recognizable sound until the brain organizes the information received from the sensory receptors in our ear. The idea that pain is an output of the brain should not be confused with dismissive statements that are often given to patients whose pain is still a mystery to their health-care provider. In some cases, when a health-care professional has not been able to identify a clear biological cause of pain, the patient or client may be told the pain is psychosomatic or "all in their head." That is not what is being implied by stating pain is an output of the brain. Pain can come from many factors, and pain without obvious tissue damage is just as real as pain felt by the person who has an observable injury. It is common to find people who have very little or no apparent tissue damage, but a great deal of pain. Conversely, it is also easy to find people who have significant tissue damage, but no pain (or pain that comes on much later than the initial tissue insult). Examples include highly competitive athletes or soldiers who were severely injured but did not feel pain because there was something more important that their brain was focused on (winning the competition in the athletic example or staying alive on the battlefield). Both of these situations produce a clinical conundrum that is difficult to explain with the former Cartesian It is helpful to think about pain as an alarm that is generated by our body, just like the alarm system that may be protecting a home.