You must choose a door

I would like to explain a curious phenomenon about one of the most important symptoms in medicine, and one that has become a workhorse for human beings over the centuries: pain. First of all, let's define what is called a symptom and a sign in medicine: a symptom is everything that the patient reports but that we cannot objectively verify: a classic example is pain: unfortunately we do not have a machine that allows us to measure it objectively; and a sign is everything that we can objectively record in a patient, for example, fever: we have a thermometer that measures it and, above all, we have a scale that allows us to compare some temperatures with others.

Once this is established, how could we define pain? Classically, pain has been seen as a defensive mechanism, which allows us to get away from what hurts us or could be harmful to us. Having a life full of pain is just as negative as not having the systems that cause it, since it fulfills many functions that we do not normally see. But like everything in medicine, there are two general types of pain: acute pain (somatic) and chronic pain (visceral). And we are going to explain each of them. Let's start with somatic pain.

Somatic or acute pain is what we feel when, for example, we prick ourselves with a needle or get hit: it is usually well defined, that is, the person who suffers it can tell us exactly where it hurts; it is faster and sometimes generates responses without the need for the pain itself to be integrated by higher centers such as the cortex: for example, if something pricks us, we reflexively pull our hand away, even before we are aware that we have pricked ourselves: this is what is called the “reflex arc”.

Visceral or chronic pain is a pain with special characteristics, such as the fact that it cannot be located with certainty, that it is not usually very intense, but because it is always present, and because of its integration, it has effects on the mood of the people who suffer from it. Of all the pains, this is perhaps the greatest enemy we face, because while the former has a great “defensive” component, in the case of chronic pain, this component disappears, because we cannot “run away” from what causes it. So this is the pain that most of the time represents a real challenge for those who practice and fight against pain.

And within this world that we are only just beginning to take a very brief look at (I can assure you that it is and continues to be one of the leading fields in both research and treatment in current medicine), I am going to focus on something curious about pain. I don't know if you remember that not long ago I spoke about the duality of pain with respect to consciousness, because it allows us to both emerge from unconsciousness (like when we wake up when we are hurt) and to fall into it when the pain is very intense (the so-called cardiogenic shock). But as I mentioned, there is another curious aspect of pain that I will later try to apply to the determination of anomalous integrations of information by consciousness. And this very curious fact that affects pain is the so-called "gate theory."

And to explain it, we are going to talk about something that is very mundane and that we have all suffered at some point: tickling. You may not know that tickling is a low-intensity pain, so low that it is not integrated as pain, but as another sensation, which we classically call tickling; in fact, remember the famous “Chinese martyrdom” of tickling: it is a pain and like any pain, over time it becomes annoying; and how do we get rid of tickling? Well, by scratching ourselves. But what mechanism does scratching follow to make tickling go away? Well, this is where the theory of the gates of pain comes in.

What we do when we scratch ourselves is to cause ourselves a pain of greater intensity than that produced by the sensation of tickling, and then, magically, the less intense pain (the tickling) disappears. But how is this possible? Well, I'm going to try to explain it in a way that we can understand. This theory was proposed by Ronald Melzack and Patrick Wall, and as always, it deals with information (in this case painful) that can be transmitted to higher centers where it becomes conscious.

This theory states that there are a series of doors (or gates) that work in the same way as a circuit: they can be open or closed when it is necessary to transmit one impulse or another: when a pain has greater intensity and somatic characteristics (as we do when we scratch ourselves) the gate is “closed” for chronic or less intense pain. But these gates are not only affected by pain, but also by each person’s mood; I am sure that many of you have suffered a traffic accident, initially with nerves, we do not feel any pain: our state of excitement or nervousness causes the gate that takes the pain to the cortex to integrate it (the information) to remain closed. As time passes, our nervousness decreases, and therefore, the gate opens allowing the painful information to pass through the spinal cord and be integrated in the form of pain: it begins to “annoy” us. Something similar is described by some soldiers who, when wounded in war, remain unchanged in the heat of battle: their body has “closed” the door that allows passage to pain.

Well, so far we have talked about pain, but now it is time to talk about what you already know I like, which is nothing other than consciousness. So remember that from now on it is only a hypothesis and personal opinion, it is not even a theory. Let us recall what we know about pain and the gate theory. Pain is a sensation, and we can think that there are other sensations that have the same “control” mechanism. And now let us take a somersault: could the anomalous integration of information that would explain some anomalous phenomena follow a process analogous to that of the gate theory of pain?

In this case, the sensations that we could call “normal” signals are those that prevent the door leading to the anomalous perception of information (in any sense) from being opened. When this “sensation” of greater intensity disappears, the door manages to “open” for the integration of the anomalous information: could this idea then explain the fact that whenever an anomalous phenomenon occurs, a kind of “sensory vacuum” is produced, either through sensory isolation (as occurs in Ganzfeld) or through the famous “vacuum bell” that many witnesses claim precedes certain anomalous phenomena? If this is so, it would really remain to be seen whether this “anomalous sensory noise” is present in all people, how it is produced and where it is integrated in the higher pathways. But as for now it seems enough to me, let’s stop here and leave for another occasion what possibilities we have for this anomalous integration of information coming from the data collected by the sense organs and who knows if by other organs.