Chronic Pain Is an Over-Determined Survival Response

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In an earlier post, “Chronic Pain Is Not a Disease,” I disagreed with the Institute of Medicine’s idea that chronic pain is a disease. Here, I propose another way to think about chronic pain. I think of pain as a survival response gone awry. Understanding the brain’s mechanism for experiencing pain and constructing emotions helps to understand this point, which is particularly important because it has ramifications for treatment.

Dr. Johannes Sobotta: An anatomical illustration from the 1908 edition of Sobotta’s Anatomy Atlas. Viewed From Right Side.

Source: • PD US • CC-PD-Mark

Initially, the posterior part of the insula (see pictures) processes these sensory inputs as subconscious body sensations that have little or no emotional component. These sensations are soon re-represented, however, in the mid-insula and then in the anterior insula to become subjective, emotion-based sensations. If strong enough, they become felt emotions—such as sadness or joy—as they interact with the anterior cingulate, prefrontal cortices, and other areas.

•	CC-BY-SA-4.0 •	Self-published work

Schappelle: The insula, center, connects to many different regions within the brain, which are noted in black text.

Source: • CC-BY-SA-4.0 • Self-published work

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