Wired into pain
Tom Jesson
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Tom,

I want to applaud you for your incredible (er, credible!) writing. As a chronic pain researcher since the early 1990s, and having chatting with Wall, calling Cliff Woolf my friend, and attending many of the seminal meetings around the early movements of central sensitization, I can say with confidence and experience that your writing is SPOT ON — as well as wonderfully engaging.

I can’t believe some of the studies I was involved in are now over 20-years old, where we began identifying the neurophysiological mechanisms that underlie the neuroplastic changes that, literally, rewire the nervous system when pain signals flood into the central nervous system over time (see our Science paper from 1997: http://science.sciencemag.org/content/275/5300/674 ). Central sensitization was just the beginning of what we now KNOW is a massive reorganization of the entire system, from periphery to the innermost neurons of the brain, changing the physiological ‘setpoints’ of not just neurons but the glia, the immune system, and many others.

That you also highlighted how vital the MIND is in the process, those being the emotions and feelings and beliefs beyond ‘simple neuronal physiology,’ is to be additionally applauded. Any chronic pain management approach that focuses on either the physiology OR the mental aspects, at the expense of the other, should be stopped immediately and the clinicians slapped long and hard until they develop their own suffering. Congratulations on advancing the fact that we are MINDBODY creatures — the two systems inseparable — and each must be tended to in order to help.

Finally, and this is NO criticism of your comprehensive writing — but an honest suggestion for your readers so that they continue their education on the history — is to look up the writings of John Bonica and Harold Merskey, two titans of the last century who helped jettison pain management into the field we know today.

I’ll end by quoting a few lines from From “The Body In Pain” by Elaine Scarry:

“…there is no language for PAIN, that it (more than any phenomenon) resists verbal objectification.”
“… PAIN enters into our midst as at once something that cannot be denied and something that cannot be confirmed.”
“To have PAIN is to have certainty; to hear about it is to have doubt.”

Thus, pain is something that we cannot NOT identify with, but we can’t fully grasp outside of our own reality.

I’d encourage your readers to continue their edification in these areas by heading over to my own writings, clapping, and joining in the discussions!

Again, thanks, Tom, for an amazing piece.