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[pain] today's articulation
A significant part of the problem is that we only start saying "all pain is in the brain" (or "the tissue isn't the issue" or whatever) to people with complex or chronic pain.
And there's a good reason for that! It's the same reason that I need to have a much more detailed idea of the fine detail of what an atom is and how it behaves than the vast majority of the population, for whom the Bohr model is perfectly adequate!
... and we need to explain that, we need to explain why we don't tell people with simple acute pain that All Pain Is In The Brain -- it's not because it's any less true for them, it's just that for most people most of the time they don't need to worry about that level of detail. But if you don't explain that, it sure do sound a lot like "your pain isn't real (unlike those people over there)".
Lies-to-children. That. That thing. That's a thing I need to explain.
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And then you (generic) run into a weird edge case, mutter "it shouldn't be doing that", and find out that something in that black-box API works as expected... for "normal" input.
... the point of this got away from me.
Thoughts
Some pain is entirely in the brain. So the only way to fix it is in the brain, or in the mind, which is hard to do because people know less about those than about other body parts. Often it doesn't get fixed.
Some pain is in the brain, but also is another part of the body that is damaged somehow. In this case, it is necessary to fix the distal damage as best it can be. That usually solves the problem. But sometimes the brain keeps saying "Leg being chewed off!" when that was over 6 months ago. 0_o
I think the biggest problem is that, unlike other things such as size of a burn or number of fractures, scientists have not yet figured out how to measure pain with a device. And they're all about devices, so anything that can't be measured to them that way is not quite real. And they are that way about pretty much everything that can't be pinned down, until it can be measured. Hell, people used to think that asthma was a mental illness!
With complex pain, you have the added problem that people in general, and medics in particular, gravitate to simple solutions. A problem with 4 different causes is unlikely to get solved.
With chronic pain, you have the added problem that people get tired of hearing the same thing over and over. That is true of pretty much all chronic problems. They've heard it, they don't want to hear it again, they're sick of accommodating it. This is why so many disabled people pull away from society: it is less miserable to be alone than to put up with other people complaining all the time about things you can't change.
I have actually heard people use "all pain is in the brain" in other contexts. It can be a useful tool, if you are deft at headskills, and you don't have painkillers for any kind of problem. Some people learn to turn it off. This has pros and cons. Which leads to another cluster of uses: soldiers, dancers, some athletes, learn that pain is in the brain and turn it off. That can be extremely useful in a crisis, but as a habit will destroy your body. Working properly, pain is a message that means "stop and fix this." If you don't, bad things happen.
Re: Thoughts
Nope!
Pain is not something you get directly from nerves: it's made up of a variety of components, including nociceptive stimulus (the thing we mostly think of when we say "pain" and aren't being strict about our terminology), contextual cues, and emotional state, along with neuropathy (damage to nerves or the nervous system) and neurogenic/neuroplastic components (either nociceptive nerves firing at way too low a threshold or the brain being primed to interpret non-nociceptive input as indicative of tissue damage or similar). Pain, sensu stricto, is an experience that is produced by the brain integrating all of these different inputs -- and that's what's meant by "all pain is in the brain".
I'm disabled, including multiple conditions commonly associated with chronic pain (more detail on which can be fairly readily gleaned by looking at my journal tags and post history); I have nontrivial familiarity with medical history, including my own disability activism; I am a scientist; I am currently in the early stages of a project to take all of the things I know and have experienced and have learned about pain and synthesise them into something useful to people who, like me, found the education provided by pain clinics actively unhelpful. (Several of my conditions are in fact associated with a propensity toward or increased risk of recurrent tissue damage, for example, so the chronic pain model doesn't fully explain my experiences.) This post is primarily a shorthand reminder to myself, but the clinical definitions are both relevant and important to what I'm wanting to do, here, so I'm going to be very insistent about using them in discussions on this topic in my space.
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It's still understandable why the shorthand is an important tool to have, absolutely, accessible layman's explanations are as important as they are difficult to come up with, but yeah (I think some of this issue comes along with metaphorical language fail, or in confusing maps with territories in general. Nnh communication, argh).
*Considers* It can also get very frustrating to have to cut off the person giving you the Bohr model explanation to advise that you're down with the valance shell model, it's fine, can we skip ahead to what we think my specific sample particle is really doing? >>;
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having to discuss pain and where and how it works for chronic conditions is one of those discussions where I do the thing, I come home, and I really really feel like humans are very bad at words and communication.
strength to your will to do the thing, kab.
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<3