A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience

Abstract

Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards non-pharmacological treatments, such as therapeutic education, exercise, and cognitive-behavioral therapy. With the advent of cognitive neuroscience, pain is often presented as a primary output derived from the brain, aligning with Engel’s Biopsychosocial Model that views disease not solely from a biological perspective but also considering psychological and social factors. This paradigm shift brings forward potential misconceptions and over-simplifications. The current review delves into the intricacies of nociception and pain perception. It questions long-standing beliefs like the cerebral-centric view of pain, the forgotten role of the peripheral nervous system in pain chronification, misconceptions around central sensitization syndromes, the controversy about the existence of a dedicated pain neuromatrix, the consciousness of the pain experience, and the possible oversight of factors beyond the nervous system. In re-evaluating these aspects, the review emphasizes the critical need for understanding the complexity of pain, urging the scientific and clinical community to move beyond reductionist perspectives and consider the multifaceted nature of this phenomenon.

Ultrasound-guided gluteal nerves electrical stimulation to enhance strength and power in individuals with chronic knee pain: a randomized controlled pilot trial

“…Despite such uniformity, the final output may reflect a net reduction in the capacity to exert force ( 82 ). On the other hand, pain as a complex experience entails affective-motivational aspects capable of affecting more complex constructs of the individual ( 83 , 84 ). In the effort to alleviate nociceptive pain, several studies have demonstrated how techniques such as not only electrical stimulation but also botulinum toxin injections lead to a reduction in symptoms along with an improvement in joint function ( 85 ).…”

Consciencia y Dolor: una mirada desde la Fisioterapia (I)

“…Recientemente se ha cuestionado el supuesto papel cerebro-céntrico para el caso del dolor persistente, debido al rol fundamental que también juega en la cronificación del dolor no solo el sistema nervioso periférico, sino incluso otros factores más allá del propio sistema nervioso (Párraga, 2023). El concepto de dolor nociplástico, además, parece sugerir que es razonable postular que un proceso que puede estar asociado con el dolor se ha activado de otra manera que no sea a través de nociceptores: de ahí la inferencia de "nocicepción alterada" o "función nociceptiva alterada" (Cohen et al, 2023).…”

Widespread latent hyperactivity of nociceptors outlasts enhanced avoidance behavior following incision injury

“…Pain after bodily injury is often accompanied by complex behavioral and neural alterations that are poorly understood 12, 58 , and may cause clinical problems long after surgery or trauma 28, 37,59 . Ongoing behavioral effects manifested acutely after significant tissue injury include spontaneous grimacing, guarding behavior, and reduced locomotor activity 12, 60, 67, 73 , while a prominent ongoing neural effect is spontaneous electrical activity in primary afferent neurons 10, 25, 39, 62, 75 .…”