The Ronald Melzacs theory of the body-self neuromatix is a big step towards understanding the nature of pain and suggesting avenues to helping patients. Scientific theories can be evolutionary in the sense of using and extending existing paradigms, or revolutionary in that it challenges existing paradigms. Melzacs theory of the body-self neuromatix is revolutionary in at least two ways. But it has an obvious shortcoming.
To summarize the theory in one sentence: the BSN is a complex widespread neural matrix with a wide range of inputs that can lose homeostasis and produce many negative changes throughout the organism. One of the negative outputs is the sensation of pain.
How do we know if homeostasis is lost? Just consider this rule-of-thumb question "Is my integrity as a healthy organism threatened?" More simply: "Am I OK?"
Here is the problem: although the theory has great negative predictive power it has very poor positive predictive power.
The negative predictive power is to ask, if the BSN has not been destabilized then can there be 'pain'? Does the existence of homeostasis preclude 'pain'? I believe time will show that pain is not possible without the loss of homeostasis. Looking to the distant past, 'pain' has been happily endured if there was a belief that it brought the sufferer closer to god. Or consider the meditator who can sit crossed legged for an hour without moving. Clearly there is bright sensory input while sitting but because there is equanimity of the BSN the perception of pain is not produced. You can not suffer if you are "OK".
Perhaps some meditators can "go to their happy place" where the woes of the world can not reach them. But most don't 'go anywhere' but instead are deeply engaged in the present moment without judgement. What distinguishes them is their maturity, perspective and patience. This helps to stabilize their BSN. There is bright sensory input, but because they are 'OK' there is no 'pain'. For them, there is no loss of homeostasis and no perception of pain.
If we had a word for 'bright intense somatic sensory input that is not associated with loss of homeostasis' my argument would be more persuasive, but we struggle to have a concept of this because we do not have a word for it. But that does not mean the phenomena does not exist.
Or consider this experiment. Put a cast iron skillet on the stove, turn the heat to low to medium and put your hand on the pan. Set your intention to keeping it there for as long as possible. You will feel the temperature change, but it will not hurt. You may get a bit anxious thinking about where this is going, but keep at it. I am sure you will find there to be a very precise, clearly defined moment when this is "too much!", when discomfort changes to 'pain'. It is not a physical issue, you could have kept it there for a bit more without significant tissue damage.
The loss of homeostasis is a central phenomena. Notice, for example, the thoughts you were having just prior to pulling your hand away. The cognitive inputs you were giving yourself was something like "This is OK! I'm doing OK! Just a little bit longer!" You instinctively were using your thoughts to stabilize your BSN. Maybe you said this out loud for further reinforcement.
Then recall your thoughts just after you took you hand away: "OW!!! THAT REALLY HURT! That was TERRIBLE! What a stupid thing to do!". These are the cognitive outputs Melzac predicts.
If you observe the physical changes you will note the avoidance Melzac predicts: rubbing the hand and running it under cold water, etc. As an Alexander Technique teacher I can assure you that you will also see shortening and compressing of the spine. Stress hormones have gone way up. Immune function altered, vascular tone changes. I doubt there is any area of the self that is not affected by the loss of homeostasis. All this is what Melzacs theory predicts.
As long as one is "OK" then there is no 'pain'.
So the negative predictive power is the BSN is very good. That is, if homeostasis is not lost, then 'pain' will not be produced. What is the positive predictive power of the BSN? If the BSN is destabilized will pain always be produced? It is clear to me that there are plenty of situations where the BSN's homeostasis is lost - where the organism is "Not OK!" - that are not accompanied by 'pain'.
Imagine a roller coaster ride that is more than you bargained for: "Not OK!" but no 'pain'.
Imagine a seeing a loved one being hurt and you are powerless to help: "Not OK!" but no 'pain'.
Imagine a the loss of a loved one: heart broken, but no 'pain'.
The most extreme example is a full blown panic attack. The victim will say "OH GOD!! I'm dying!!" You may ask them: are are you in pain? "I CAN'T BREATH!". Yes, yes, but are you in pain? "HELP ME!" Does it hurt anywhere? No? In this case, it does not matter if there is 'pain'. The obvious problem is loss of homeostasis and the profoundly negative outputs. But the output of 'pain' is null. The BSN is not creating pain. Why?
What place does the BSN theory play if it can not predict pain? What is the broader picture that makes sense of this?
My question is how to we put all this to work to help those who are suffering? Better yet, can we follow other medical fields and start thinking about the prevention of suffering?
This is not merely an intellectual problem for the amateur pain theorist. Chronic pain - and the subset of narcotic prescriptions - are arguably the greatest problems in medicine within the US today. Answers to these questions are extremely pressing and important.
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