General lecture held on October 21, 2018"What is pain? -The abyss world-". Thanks to all of you, 60 people were sold out last time and the time before last.
The following is a partial rewrite of an interview article by a media representative.
prologue
I recently participated in a lecture on the theme of "the relationship between the brain and pain." The theme was "What is pain? -The abyss of the world-". Organized by the BFI Kenkyukai. This is the 4th lecture for the general public.
According to the organizers, theoretical explanations have been exhausted in three lectures so far: ``Pain Memory Reproduction Theory,'' ``Brain Fatigue and Touch Care,'' and ``What is the Ultimate Touch Care ``BFI''? For this reason, the main purpose of this article is to report actual cases.
When I finished the reception first, I was handed a piece of A3 paper.
The materials they gave me were part of the slides shown in a past lecture, and when I looked through them one by one, I intuitively felt that the relationship between the brain and pain was explained under the concept of brain fatigue. I was. Thanks to this, even a student who participated for the first time was able to have a rough image.
aetiology of pain
The time of the lecture is from 12:30 to 15:00, and it is composed of three parts with two breaks in between. Explanatory diagram) starts from the production that you can experience.
After staring at a specially-processed landscape painting for about 20 seconds, the moment the same landscape painting switches to a monochrome image, for a moment it appears as a vivid color image. You can definitely see a very realistic color image, then black and white... I experienced a very strange phenomenon.
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According to Mr. Mikami, the lecturer, these illusions created by the brain are called "complementary", and the brain "creates" a wide variety of other illusionary phenomena, and the neural circuits that express pain are also similar to this. There are cases where it is “created” by the same mechanism as complementation, and moreover, such pain is said to be “often in clinical practice” in ways that would be unthinkable in conventional common sense.
Pain originating in the expression of information in the brain is a sign that indicates a logical obstacle, that is, a software application problem, if compared to a computer."Soft Pain", pain due to injury or inflammation is a sign that indicates a physical disorder, that is, a hardware problem (part failure).hard pain, the mixed pain of both is ``hybrid pain”, and is proposing a new classification – a paradigm shift in the concept of pain.
On the other hand, in the medical books, ① nociceptive pain (hard pain),(2) Neuropathic pain(hard pain),(3) It is classified as psychosocial pain (soft pain), but...
these days(2) Neuropathic painIn the background that the term came to be seen frequently in TV commercials ….
Recent studies have shown that narcotic analgesics and antidepressants, which primarily target the brain, affect the dorsal horn of the spinal cord.Descending inhibitory system (*)Taking the opportunity of getting approval (paper report) to be involved in
To prescribe drugs that act on the descending inhibitory system
BReIN
Therefore, after explaining that "your pain is neuralgia" at the examination site,Medications formerly prescribed for cancer pain and depression are now given for chronic painThat's what I'm talking about.
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〈Mirror TherapyAccording to Mr. Mikami, it is natural to think that the identity of pain that improves is not hard pain, but soft pain.>
Mirror therapy is a technique that promotes plasticity in the brain, so the pain that it improves can be considered a soft pain. In other words, the pain of frozen shoulder is not "damage or inflammation of parts (hard pain)" as explained by existing medicine.
Since not only the pain but also the movement (range of motion) is restored, it is known that the reason why the arm cannot be raised is the brain dimension (motor circuit output error).
Furthermore, since there are cases where "only pain remains unchanged even after movement is restored" and vice versa, when "activation of the pain circuit" and "error of the motor circuit" in the brain are synchronized, "arms cannot be lifted." If it is not synchronized, in other words, if it is one or the other, it will result in an analysis that says, "Somehow it goes up, but it hurts anyway..." or "It doesn't hurt that much, but it just doesn't go up...".
BReIN
We take an approach (a type of touch care called “BFI” that our association is researching and developing) that promotes brain plasticity for all musculoskeletal disorders and pain diagnosed as neuropathic pain, not just frozen shoulder. Over time, I've come to realize that most pain is actually a soft pain.
Our clinical data show that there is very little genuine neuropathic pain (hard pain). In the first place, it is because of soft pain that drugs that act on the brain show their effects.
However, due to the insurance coverage of medicines, the reality of the pain is distorted and transmitted to the patient, and as a result, the curse of "neuralgia" is cast on the patient. We are led to believe that it hurts because the nerves are damaged, or that the pain is because the nerves are compressed... that kind of grave situation." .
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When I heard that, it certainly reminded me of a TV commercial in which the word "pain" was strangely emphasized. Such circumstances were hidden behind the unique way of speaking by a great actor...
According to Mr. Mikami, the concept of pain in existing medicine is chaotic and undefined, and when the concept of pain in folk remedies around the world is mixed with this, it is nothing but chaos. That's right.
What lies at the root of this is that many medical professionals say that they are "painful"body”, and said, “I am in pain.individualHe argues that there are too few sites that are trying to face this, and as a result, there are still few medical professionals who can see the brain dimension, which is hindering the global unification of pain concepts.
That said, even if we did get to the brain dimension, would researchers be on the same page? Among such medical professionals, various theories of brain etiology are being discussed.
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In the background, there is a problem in the diagnostic philosophy when enjoying brain science, and with the recent development of brain function imaging,It seems that too many researchers have fallen into brain localization theory. He was very concerned about this situation.If things go on like this, they will end up in the same rut as plastic surgery diagnostic imaging...When.
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"For example, functional brain images such as fMRI show the localization of oxygen consumption and blood flow, but the difference in energy consumption between the red area and the blue area is only a few percent at most.
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The brain as a whole is always working in an integrated and coordinated manner, and not just any part of it. The brain is truly a black box, an extremely complex system, and in the future we should be able to elucidate not only nerve cells (neurons), but also glial cells, which have been treated as lentigines.
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One-third of those with Alzheimer's picture changes never actually develop. The brain is a world as deep as the universe... We must never repeat the plastic surgery mistake of short-circuiting changes in images and pain.』
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says enthusiastically. Several books on software theory that were published after being exposed to TV programs and mass media led by researchers of brain localization theory were introduced.
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“The functional decline of the nucleus accumbens and DLPFC, overactivity of the amygdala, etc. have been taken up, but the relationship between these and pain is a correlation, not a causal relationship (
BReIN
For example, localization points out that when an orchestra's performance is not good, some violinist, some viola player, and some oboe perform poorly. It is Mr.'s point of view that it is the fault of the person.
Among human organs, the brain is particularly vulnerable to oxygen deficiency, in other words, the brain, which is highly dependent on oxygen for energy metabolism, has its own homeostasis that responds sensitively to its own blood flow balance (he calls this blenostasis). ), and a minute disruption of this function causes brain fatigue.
The micro-rupture of plenostasis activates the pain circuit using the "complementary" mechanism introduced at the beginning. As a result, the increase in blood flow in the same circuit promotes the recovery of metabolic balance. In other words, pain is a signal that informs brain homeostasis dysfunction (BD), and at the same time, it also has a role in restoring this.
Software problems (bugs) in computers are described as "logical obstacles," but soft pain in the human brain is said to be a "disorder". As congenital painlessness implies, it should be regarded as one of the crisis avoidance systems that protect lives.
As mentioned above, the "brain, which is the ultimate in complex systems," is expected to have a long way to be fully elucidated at the current scientific level. How is consciousness created?"
In that sense, he predicts that the research results of quantum mechanics will eventually lead to a breakthrough.
Factors that cause brain homeostasis dysfunction (BD) are divided into extrinsic factors and intrinsic factors.
The former is an environmental factor including climate change symbolized by meteorological disease.
The latter includes brain-gut correlation, that is, disturbance of the intestinal environment and disturbance of mental balance.
The brain localization theory, which has been popular in the mass media recently, is extremely incomplete as a cause of pain. brain research may provide a different perspective.
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However, I believe that this is the most rational interpretation among the existing causal theories.
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With the development of functional brain imaging, it becomes possible to see things that were previously invisible. Researchers are required to have a point of view.
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BReINWe must never repeat the misleading that has allowed the structural collapse of pain to be ingrained into the human brain.
After introducing a bird's-eye view of the etiology of pain, he explained the difference between psychosomatic medicine and psychiatry.
soft pain and hard pain
Psychiatry is a department that mainly deals with psychosomatic diseases (mental problems → physical disorders), and psychiatry is a department that deals with mental illnesses such as depression (mental problems → mental disorders). Was introduced.
As for these two, I thought that "both are similar", so I couldn't hide my surprise, "Is there such a difference!"
In addition, the word psychosomatic disease was used in the crash of a JAL aircraft off Haneda (Captain Stop!), and many people still have the wrong image of it. I was able to renew my understanding of it.
Even so, many of the diseases that are common in everyday life are treated as psychosomatic disorders. A book was introduced, followed by an explanation of a number of cases of recovery in psychosomatic medicine.
In front of the intense soft pain created by the unconscious anguish of a popular writer, a famous pain doctor, all kinds of painkillers, a master manipulative therapist, and a fortune teller continue to bow their heads and lose, until the very end. Such real and intense pain cannot be psychogenic." By relying on the other person (a psychosomatic medicine doctor) who continued to stubbornly oppose him, he finally miraculously survived.
Shizuko Natsuki visits a psychosomatic medicine department and interviews her "comrades" in the shocking ending that the true identity of the intense pain that causes her to think about suicide is actually soft pain. He also talked about cases in which not only low back pain but also intractable diseases such as ulcerative colitis were cured.
According to Mr. Mikami, most of the cases like Shizuko Natsuki's "life-destroying pain" last for a long time are soft pain.Soft Pain Accompanies 'Impossible' Skin ChangesAn actual clinical case was introduced by Mr. (pictured below).
BReINIn the photo above, the left end is a rib fracture, and the others are psychogenic. It's hard to believe that such a skin change can be caused by a problem of the heart... Among them, the photo of the foot on the right is called `` blood sweat '', and it seems to be a rare disease with only dozens of cases reported worldwide.
It is a very rare phenomenon that blood is mixed with sweat, but it is described in the Bible in ancient times, and it is written that Christ sweated blood the night before he was crucified. It has been confirmed in his clinical practice that this phenomenon also appears due to strong psychological stress.
CentralThe photograph of the hand (swelling redness → edema gloss) is Complex Regional Pain Syndrome/CRPS (RSD) that developed in his mother.
BReINAmong the various types of CRPS (RSD), his mother had spontaneous onset (suddenly during sleep, a severe pain attack occurred in the right hand, and a few days later, the state of the picture appeared...), but this disease group Since it often appears after an injury such as a bone fracture, the existing medical field seems to be dominated by the hard pain bias—the preconceived notion that pain arises from the site of injury.
However, according to Mr. Shizuko Natsuki, most of them are pains of the same nature (soft pain), and problems of the sympathetic nerves - swelling, edema, skin changes, tissue atrophy - are synchronized or not. He asserted that it was nothing more than a dimension.
BReINmoreoverThe clinical experience, in which she continued to confront her mother's severe pain day and night, was a very valuable opportunity to realize that "soft pain has a role in avoiding major depression and dementia, which can lead to bedridden people." and rare experienceIt seems that it was.
By the way, it seems that the true cause of CRPS (RSD) in his mother - the real culprit - was his son, in other words, "Mr. Mikami himself".
A mother who lived with her husband for a long time. One day his life changed completely. Due to circumstances on the side of the son (Mr.) and his wife, they suddenly had to live together...
However, half a year after they started living together, tension broke out between her husband and son (Mr.). It was the onset of being caught in that dilemma and wearing down my spirit.
BReINIn fact, she had been in a depressed state for several months, and the mother's brain ``avoided major depression (prevented the severity of the depression)'' by producing intense soft pain on its own, according to Mr. interpretation(It can also be said that dementia was avoided at the same time.)
BReINEven so, it is really surprising that such a change is caused by a problem of the heart, but in a sense it may be a phenomenon that symbolizes the creature called human beings.
Until now, the medical community haspain = hard pain'' I firmly believed.
Certainly, as symbolized by severe pain such as subarachnoid hemorrhage and aortic dissection, hard pain, which informs the danger of life, has a strong impact and is imprinted in the memory and knowledge of medical personnel. However, in developed countries with well-equipped emergency medical systems, treating the underlying disease often leads to the disappearance of pain.
Such hard pain itself is rarely “treatable”. He argues that most of the problematic cases in the dimension of pain control, the 'chronic pain' that plagues and afflicts people, are not life-threatening signs, but soft pains.
When cancer is found in patients with chronic pain such as back pain and stiff shoulders, it is easy to think, "That back pain that I have been feeling for a long time was caused by cancer." There is no scientific basis to prove the relationship between cancer, and it is logically consistent to think that cancer was found in a living organism that produces soft pain, that is, that two phenomena of different dimensions were synchronized in the body throughout life. Excellent."
In his opinion, what is thought to be cancer pain (pain caused by cancer) actually includes a considerable number of soft pains. You can
“The development of cognitive neuroscience, psychosocial approaches, and clinical research on brain plasticity (one of which is the BFI Research Group) have shown that soft pain is not a rare occurrence that seems to be a cornerstone of the jubako, but is actually hard. It turns out that there are overwhelmingly more than Payne, and suchIt is necessary to reflect the paradigm shift of pain in textbook descriptions as soon as possible.' he insisted in a strong tone.
One of the typical hard pains is injury pain (traumatic pain). Even this, the time to feel it is "actually shorter than expectedThis is what he has confirmed through the human experiments he has imposed on himself.
BReINIt's an unbelievable experiment in which you drop a glass plate on your leg and break it. As a result of doing this, it seems that pure hard pain due to acute trauma does not last for tens of seconds, and it immediately transitioned to hybrid pain, and the pain felt 48 hours later was definitely soft pain, according to his analysis. .
In response to the difference in skin findings two days after the injury (the photo on the far right above), he argues as follows.
BReIN
This is just my personal opinion, but the selection of signal input (opening and closing of the gate) is ultimately above the spinal cord, that is, in the brain, the default mode network (*) and other synchronous wide-area neural circuits are in charge of this function, and since it is inferred that they form the boundary between consciousness and unconsciousness, I call this the boundary consciousness circuit.
※…
It's a world beyond the reach of an amateur like me, but in a few hundred years from now human society will "The Soft Pain Theory of Pain" is becoming common sense, is Mr.'s vision of the future.
Well, the preamble (preface) has gotten so long, but now it's finally time for the main part of this lecture - what kind of life drama did the people who give the soft pain and what kind of salvation come? -I will introduce you.
The “paradigm shift in pain” he advocates… Let’s call it a journey to trace its origins, the driving force – the atmosphere of the examination site – is vividly felt, as if being shown a reenactment VTR. Like this, a solo performance full of realism by Mr.
All the personal information of the cases introduced in this lecture is, of course, hidden, and all proper nouns such as name, age, occupation, family structure, area name, etc. are all replaced with fiction, and only the context of the story is faithfully reproduced. It is said that there is.
Case 1
Case 1) is a reactive disorder that developed in an elementary school student with a developmental individuality (*) borderline case - a case that has the tendency even if it does not lead to a definitive diagnosis. His point of view is that the essence is brain fatigue.
(*)…BFI study groupInstead of using the term developmental disorder, the term "developmental personality" is recommended.
For a series of symptoms such as abdominal pain, diarrhea, fatigue, and severe back pain, he passed through the core of the patient in internal medicine, pediatrics, and orthopedics. , guidance on dietary habits, follow-up on the mother's mental aspects, and the wonder of counseling performed after seeing through the stubborn nature of the person who resolutely does not accept psychological intervention.
It was a case where Mr. Ishikawa's intervention to maintain an optimal sense of distance was successful, and it was a good example of "visible" how a relationship of trust with a patient is built through a delicate and careful process.
The diagram below shows the classification concept of developmental personality (see DSM-5).
According to Mr. Mikami, nowIt seems that developmental individuality is increasing explosively ... The reason can be explained from the viewpoint of Gaia theoryThat is his view. Regarding this, he said, "I would like to have another chance to give a lecture."
“Actually, I myself have a developmental personality.
Regarding the relationship between developmental personality and painthis pageis explained.
Case 2
Case 2) is a “fighting” case in which a man who has suffered from the side effects of antidepressants tries to escape from it without relying on drugs.
A life-or-death escape drama in which he managed to survive through day after day of treatment, listening to medical questions, and light interpretation counseling for a dangerous situation accompanied by suicidal ideation. His realistic oral presentation about this case isThis page (YouTube)You can watch it at
Case 3
Case 3) is a case of a woman who was said to have mild cognitive impairment (MCI). He decided that he had already developed dementia, and told his daughter (eldest daughter), who was accompanying him, that he needed to know the details of the development, but for some reason he was uncooperative.
According to him, the risks of dementia include masking of brain homeostasis dysfunction (BD) and some sort of psychological repression. That's right.
While it is almost impossible to know what is going on at home, only improvement in cognitive function due to BFI treatment appears. The flow of improving only the symptoms without knowing the actual situation of the patient seems to be unsatisfying because it is not his intention... However, the eldest daughter's decision to stop going to the hospital is heartless...
However, a few months later, the second daughter who lives with him visits the hospital, and the mystery is solved at once.
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case 4
After receiving the second daughter's testimony, the mother's past is finally revealed. After discovering that behind dementia, there are husband's problems - family power harassment, neighbor troubles, alcoholism, etc. - I will continue to provide polite advice and light interpretation counseling tenaciously for more than two years. So, indirectly improving her mother's dementia through her second daughter who lives with her...
The second daughter herself has a more violent past than her mother, and the background to her depression is becoming clearer.
The effectiveness of light interpretive counseling - the true power - was revealed while approaching the relationship with his father, who must have had a great influence on his character development. When the door to her unconsciously sealed memories opens, she realizes her father's clumsy but unconditional love, and when she cries, voices of sobbing can be heard all over the venue.
And when the parent and child overcame each other's destinies and were saved, the touching ending was met with spontaneous applause from nowhere.
case 5
Case 5) is a case of iatrogenic pain awaiting a woman diagnosed with osteoarthritis who underwent arthroplasty of hip and knee joints. Violent corrective action performed by a surgeon who is too ignorant of pain. A young PT (Physical Therapist) who is under pressure from the surgeon and has to produce results. Danger lurking in the field where the relationship between the brain and pain is unknown...
A woman who stumbled upon the website of the BFI Study Group when she researched the relationship between rehabilitation and pain on the Internet said that she was treated by BFI (
However, according to Mr.'s attentive questioning, this person is also in the midst of family problems. While the elderly mother who lives alone is developing depression, she herself is also single and cannot decide to live with her. Once again, when his internal conflicts came to the fore, his skillful listening and questioning opened the door to salvation.
A ray of light comes in that melts the ice in the person's heart... And no more happy ending. Its contentsThis page (YouTube)You can watch it at
"There is no end to the number of cases in which people have gone through complex and unstable processes in the field of plastic surgery and rehabilitation, and have grown distrustful of medical care and have shifted to doctor shopping..." tinged with….
"...That's why we need to rewrite the textbooks. Young medical professionals who are crammed with knowledge to pass the national exam, accept the books with a grain of salt and come out to the field... You need to be properly educated about the reality of soft pain before you become a member of a group or academic society.”
case 6
Case 6) isA classic example of the tragedy caused by looking at the affected area and not looking at people - not looking at the forest for the trees. A case that clearly shows how the belief that CRPS (RSD) is a hard pain can derail a patient's life.
Because the timing of the surgery happened to coincide with the occurrence of a major incident that caused extremely serious damage to the person's mental state - a shocking event in which the beloved only daughter suddenly sent an "unreasonable letter of insulation" - the autonomic nervous system was damaged. Disturbance of this brings about skin changes similar to his mother's...
The surgeon prematurely assumed that this was a symptom of nerve adhesion, and as a result of repeating nerve ablation three times, the hellish days of being attacked by abnormally burning pain.
He seeks help from SCS (Spinal Cord Stimulation Therapy) and decides to implant a device with a built-in battery inside his body. However, although it was effective during the trial, when I actually implanted it in my body, it did not show any effect after that.
This caseIt is revealed by listening carefully to Mr...
The process of solving the mystery of the person himself was a battle of attrition, going back and forth between maintaining and breaking up the relationship of trust with the patient, stepping on landmines many times during the several years of hospital visits. was told.
By the way, this case is a non-output type for both numbness and numbness. "In all my life, I've never felt tired. I don't even feel thirsty, so I don't usually drink water." Typical brain fatigue masking type>
Cancer pain and soft pain
In this way, when all six cases were introduced, the time was up. .
As mentioned above, according to him, cancer pain includes a considerable number and a considerable level of soft pain.
The figure below is an experiment comparing the pain relief rate for each group, divided into a group that took a real pain reliever and a group that took a placebo (a placebo with no efficacy).
What kind of pain does placebo improve? That's what he claims is a soft pain, and if it's true, the numbers are nothing short of staggering...
Finally, he introduced an unforgettable experience (a case) that made him pay attention to the relationship between cancer and soft pain.
A woman in her 70s with severe knee osteoarthritis (severe X-ray findings and apparent bow leg deformity). I received conservative treatment at more than 4 hospitals, including Mr. Ishikawa's, but the pain could not be controlled, and at the time when I decided to have knee surgery, stomach cancer was discovered by coincidence.
As a result, the stomach surgery was successful, and the woman, who had a good luck, visited him again immediately after being discharged from the hospital. It seems that the reason for the consultation was not the knee, but the back pain that appeared during hospitalization.It was said that deformity was the cause that tormented women so muchkneesWhat a pain! It seems that it has completely disappeared (…despite the X-ray findings and bow leg deformation).
As he repeatedly argued in this lecture, this woman's knee pain was nothing more than a soft pain.
From the moment she found out she had stomach cancer, the woman's head was filled with just that, and she completely forgot about her knee. What if her pain wasn't in her knees, but in her back? I'm sure I should have looked back and said, "My back pain was due to stomach cancer." It just happened that the location of the pain was a part (knee) that was far from the stomach, so I didn't think about the relationship with stomach cancer.
introduced earlier……It is more logically consistent to think that cancer has been found in a living body that produces soft pain, that is, that two phenomena of different dimensions have just synchronized in the body for the rest of their lives.His idea of "is based on such accumulation of clinical practice.
“In this way, actual clinical trials clearly show the relationship between cancer and soft pain! Someday, if it is proven at a professional conference that the proportion of soft pain in cancer pain - the incidence rate in all cancers or the proportion of hybrid pain in one individual is high, it will be possible to treat cancer. can shine a new light on...
From that point of view as well, he said that he wanted to evoke the concept of soft pain, and the event came to an end.
summary
Finally, a few words from the students.
As far as I know, I have never seen a lecturer like him who speaks so fast for nearly 3 hours. I was overwhelmed by this, and it was a good opportunity to reconsider whether it is sometimes necessary to question my common sense.
And above all, the most impressive thing was the contents of the interview by Mr. Attitude to listen to every element related to living environment. If you make a mistake, you will be mistaken for a detective's questioning, so thorough information gathering that you can feel something like obsession. And after all, his “listening power” is amazing. This really took me by surprise.
Where does that passion come from? When I asked him after the lecture, he gave me a very easy-to-understand answer.
BReIN
Even if you read 100 papers a day or dozens of books a month, it is meaningless if you do not have the ability to understand the causal relationships that correspond to the time series that the patient embodies... , It depends on the clinician whether excellent research papers can be used or killed... How well can you think in a balanced way between theory and reality?
Of course, there are some patients who feel uncomfortable with persistent medical interviews... Therefore, it is really delicate and steady work to carefully consider the feelings of the other person, respect them, and gradually reduce the sense of distance. Repeating is my current job
I see…. By the way, when I asked him about future trends, he said that he was envisioning something called the Japan Society for Cognitive Science and Integrative Therapy in the future, and I am curious about the direction of such efforts.
Well, Mr. Mikami's answer to this grand theme of "What is pain?"
"Emotional output response that cannot be verbalized by opening the gate of boundary consciousness"
That's right.
This concludes the summary report of the general lecture "What is pain? -The abyss of the world-".
From a questionnaire of participants
Below are some excerpts from the participant survey. Due to space limitations, we are unable to introduce all of them, but we will keep in mind the valuable opinions we received from all of you and use them in our next lecture. I would like to express my sincere gratitude to everyone who attended.
Follow me!
For those interested in Cognitive Science Integrated Approach (COSIA)
In the current situation where image labeling and diagnosis of the cause of pain diverge, the International Association for the Study of Pain (IASP) has revised the definition of pain and is shifting to the "emotional origin theory of pain."
If you are interested in COSIA, please visit the "Special Site for Medical Professionals and Therapists". We look forward to your participation.
