Pain is not “in” your tissue

Pain is not “in” tissue. In fact, the only thing that happens in the tissue is transduction — the conversion of stimuli into nerve signals that do not yet “mean” anything. They are meaningless until they get to the central nervous system. The CNS decides what they mean.

In the case of a computer, the separation of signal and interpretation is nice and obvious: a computer decides what a mouse click “means” … not the mouse.

We can’t detect this separation. As far as we can tell, there’s no practical difference between the signal and the interpretation, because the huge majority of the time the system works brilliantly well: actual tissue problems are interpreted “correctly.”

As far as we can tell, there’s no practical difference between the signal and the interpretation.

In chronic pain, though, the interpretation often gets increasingly out of whack with the signal. This is called “centralization” of pain — the experience of pain is now dominated by the CNS, and it matters less and less what’s really going on in the tissue. The state of the tissue may be almost irrelevant! The problem may feel dramatically worse than it really is. For the chronic pain patient, it becomes important to understand that the brain is in charge. Even for someone with a stubborn tendinitis, this can be a vital principle to understand.

This concept may explain why therapies that try to “fix the tissue” — most of them — are so generally ineffective.