Brook Cheng

Jun 20, 2026

Why modern medicine became lost in trivialities while high‑school neuroscience already points to the escape route

Abstract

Pain medicine has produced more theories, constructs, and treatment paradigms than any other field in healthcare—yet clinical outcomes have barely improved in half a century. This stagnation is not due to the inherent complexity of pain, but to the complexity of the noise surrounding it. The field has drifted away from the fundamental biological principles that govern all living organisms, from bacteria to humans.
High‑school neuroscience already provides the core, mechanistic truth: pain is always mediated by neural signaling, and no psychological or social factor can influence pain without acting through the nervous system.
This article examines how pain medicine became lost in conceptual clutter, why the noise persists, and why the escape route has been visible all along—anchored in the simplicity and efficiency of natural biological design.

1. The Paradox of Modern Pain Medicine

Humanity can land spacecraft on the moon with meter‑level precision.
We can sequence the human genome.
We can build artificial intelligence capable of reasoning, writing, and diagnosing.

Yet in musculoskeletal and chronic pain medicine, the global scientific output of the last 50 years has produced a sobering conclusion:

No dominant therapy reliably outperforms placebo by more than a trivial margin.

Machado et al. (2009):

• SMT: 1.4% above placebo

• Exercise: 1.7% above placebo

• Acupuncture: 19% with massive variability

• Most therapies: no better than NSAIDs, magnets, or placebo

Cochrane meta‑research (Momosaki et al., 2019):

• Only 5.7% of physiotherapy systematic reviews were conclusive

• 94.3% were inconclusive or contradictory

This is not scientific progress.
This is scientific stagnation.

2. The Root Cause: A World Drowning in Clinical Noise

Pain medicine is not failing because pain is inherently mysterious.
It is failing because the field is drowning in noise—a self‑generated ocean of:

• pet theories

• biomechanical myths

• invented constructs

• unproven assumptions

• diagnostic labels without mechanistic grounding

• treatment paradigms built on obsolete models

The fuzzy cognitive maps of low back pain—142 factors, 1,161 weighted connections—do not reflect biological complexity. They reflect conceptual confusion.

As Álvaro Hidalgo Castillo observed:

“This reflects how heterogeneous clinical practice and human opinion are, rather than accurately representing the complexity of low back pain.”

The map is not the territory.
In this case, the map is a mirror—reflecting our collective uncertainty.

3. The Fundamental Error: Naming the Pain Instead of Knowing It

Richard Feynman warned:

“When you know all the names of that bird in every language, you know nothing about the bird.”

Pain medicine has become a discipline of naming:

• “biopsychosocial pain”

• “neuroplastic pain”

• “myofascial pain”

• “subacromial pain syndrome”

• “non‑specific low back pain”

• “central sensitization”

Each new label creates the illusion of understanding while adding another layer of noise.

But none of these names answer the only question that matters:

What is pain, in biological terms?

4. The Fundamental Truth: High‑School Neuroscience Already Told Us

Strip away the noise.
Return to first principles.
Apply Musk’s physics‑style reasoning:

“Boil things down to their fundamental truths.”

The fundamental truths of pain are not controversial:

1. Pain is a perception generated by the brain.

2. The brain generates this perception only when it receives neural signals.

3. These signals originate from afferent pathways—never efferent ones.

4. No afferent nociceptive input → no pain perception.

This is high‑school neurobiology.
It is not a theory.
It is not a model.
It is a physiological fact.

From this, one conclusion follows with mathematical inevitability:

Any intervention that does not modulate afferent neural signaling cannot reliably eliminate pain.

This single sentence explains 50 years of failed RCTs.

5. The Directionality Error: Treating Effects Instead of Causes

The entire MSK world has been treating efferent effects:

• stretching muscles

• strengthening muscles

• mobilizing joints

• correcting posture

• manipulating spines

• massaging fascia

But pain is not an efferent phenomenon.
Pain is an afferent phenomenon.

Trying to eliminate pain by manipulating muscle fibers is like:

Trying to fix a software virus by polishing the computer monitor.

The CPU—the nervous system—remains untouched.

This directionality error explains:

• why stretching and strengthening rarely outperform placebo

• why SMT hovers at 1–2% above placebo

• why 94.3% of physiotherapy reviews are inconclusive

• why clinicians keep “doing the same thing over and over expecting different results”

The field has been treating the effect while ignoring the cause.

6. Why the Biopsychosocial Model Became Noise

The BPS model correctly identifies that biological, psychological, and social factors influence pain.
But its fatal flaw is that it lacks a mechanistic hierarchy.

It mixes categories of influence without identifying the biological process that unifies them.

Here is the missing hierarchy:

6.1. Pain is always mediated by neural signaling.

No neural signal → no pain.

6.2. No psychological or social factor bypasses the nervous system.

Fear, expectation, trauma, culture—
all act through neural modulation:

• altering afferent gain

• modifying spinal processing

• shifting cortical prediction

• changing descending inhibition/facilitation

Psychology does not replace biology.
It modulates biology.

6.3. Afferent neural signaling—not efferent output—is the base layer.

This is the layer that must be targeted for rapid, reliable pain relief.

Without this mechanistic anchor, BPS becomes a conceptual fog—elastic enough to explain anything, but too vague to guide precise intervention.

7. Nature’s Simplicity: The Missing Compass

Pain medicine behaves as if pain requires 142 variables and 1,161 weighted connections to understand.

But the human body is a product of nature—
built on the same principles as a single bacterium:

• ion gradients

• membrane potentials

• signal transduction

• homeostatic regulation

• energy minimization

Nature operates with unimaginable efficiency on very simple rules.

Pain turns on in <250 ms.
Pain can turn off just as fast.

When a human theory becomes more complex than the phenomenon it attempts to explain, the theory—not the phenomenon—is the problem.

A theory that adds variables instead of reducing them is moving away from truth.

This is why pain science has stalled for 50 years.

8. The Escape Route: Return to Afferent Physiology

If pain is an afferent neural phenomenon, then the only scientific path forward is:

• identify the specific sensory receptive fields generating the abnormal impulses

• modulate or reverse those impulses

• observe immediate changes in perception

This approach is:

• testable

• falsifiable

• reproducible

• grounded in basic neurophysiology

And it explains why:

• pain can turn on in milliseconds

• pain can turn off just as fast

• any reliable therapy must operate on the same timescale

The body already contains the “pain‑on” switch.
Nature does not design one‑way systems.
The “pain‑off” switch must exist—and clinicians must learn to locate it.

9. Conclusion: Pain Medicine Needs a Scientific Reset

Pain medicine is not failing because pain is complex.
It is failing because the field has mistaken noise for signal, names for knowledge, and effects for causes.

The path forward is not more complexity.
It is less.

• Less jargon

• Less biomechanical mythology

• Less theoretical ornamentation

• Less noise

And more:

• observation

• physiology

• afferent neuroscience

• immediate, testable outcomes

Pain science will advance only when it stops polishing the monitor and starts debugging the CPU.