PSYCHOGENIC PAIN

What is Psychogenic pain ?

Psychogenic pain describes both short- and long-term episodes of pain that occur as the result of some underlying psychological disorder, rather than in response to some immediate physical injury. Brief episodes, as well as persistent symptoms, are indeed very real and painful for those experiencing psychogenic pain. 

Although some cases of psychogenic pain occur in response to a previous injury, in rare cases, the pain stems purely from a mental ailment. In most cases, however, psychogenic pain causes existing pain as the result of some physical stimulus to feel more intense. Because the brain is the center for deciphering levels and location of discomfort, individuals with an underlying emotional disturbance are at higher risk for exhibiting psychogenic pain. 

Another feature of psychogenic pain is that it can be one of two types:

• acute (pain that spikes briefly and then goes away)
• chronic (pain that persists and recurs over the course of weeks, months or even years).

While a one-time occurrence is incidental and usually requires no further treatment, chronic types of psychogenic pain will demand treatment that depends on the type of pain a patient is experiencing.

How Psychogenic Pain Originates

Although researchers have investigated the sources and causes of pain, the medical community is still baffled by how the brain interprets this sensation. Our bodies contain massive networks of nerve receptors that transmit messages up the spine to the brain. Once these signals reach the brain, the brain figures out what area of the body is hurt, how badly it is hurt and what you should do to alleviate or minimize the pain. 

However, because our bodies have so many nerve receptors, signals from different areas of the body can become crossed easily. When pain signals cross each other, you are likely to misinterpret the type, location and/or sensation of pain you are actually experiencing. For example, while your body may “feel” pain in one part when the pain is actually in another location (known as “referred pain”), crossed nerve signals can also cause you to experience pain without any stimuli, as is the case with psychogenic pain. 

The fact that the subconscious mind produces psychogenic pain leads some professionals to believe it is "all in the head." However, because the symptoms of this type of pain are real and can seriously affect patients, all cases of psychogenic pain should be taken seriously and be thoroughly investigated to identify the underlying psychological disorder responsible for producing the psychogenic pain.

 For example, non-specific (or psychogenic) chest pain syndrome commonly occurs in individuals under the age of 50. These patients typically experience symptoms that include chest wall pain, as well as radiating arm and neck pain. While some patients mistake these symptoms as the early warning signs of a heart attack, in most cases, chest pain syndrome arises from an underlying anxiety and/or panic disorder. As a result, treatment for these patients should revolve around treating the psychological disorder to prevent chest pain syndrome from recurring.

Causes of Psychogenic Pain

Experts have come up with three theories that claim to identify the causes of psychogenic pain:

• Theory 1: Underlying psychological factors cause psychogenic pain.
  
  These include:
1. anxiety disorder
2. bipolar disorder
3. depression
4. obsessive-compulsive behavior
5. panic attacks.
• Theory 2: Psychogenic pain results from some previous injury that hasn’t yet fully healed. In this theory, emotional issues result from (but don’t cause) the pain and can intensify it if the underlying physical cause of the pain isn’t treated.
• Theory 3: Psychogenic pain causes existing pain to feel worse than the situation actually warrants. According to this theory, psychological issues cause patients to feel exaggerated, more intense pain by comparison to the extent of physical injury or disease. While their sensations of pain are real, the underlying mental disorder plays a role in intensifying the pain.

Symptoms of Psychogenic Pain

Psychogenic pain disorders, when chronic, produce a variety of symptoms. The pains can be mild to severe and dull or sharp. Generally, psychogenic pain causes the following symptoms:

• constant discomfort despite taking medication
• difficulty describing the location, quality and depth of pain
• non-localized pains that encompass larger parts of the body
• worsening pain independent of any underlying medical condition.

If these symptoms exist in absence of any chronic disorder with physical cause, the patient likely suffers from psychogenic pain.

Diagnosing Psychogenic Pain

When a patient sees a doctor about pain, his doctor will first make all attempts to identify a physical cause of the pain. If the patient is known to suffer from an emotional disorder, and no physical element can be identified as the source of pain, then the doctor may start to suspect that psychogenic pain is the cause.

After performing a series of tests (including MRIs, CT scans, blood tests, etc.), the doctor will be able to rule out or diagnose psychogenic pain.

Psychogenic Pain Treatments

Once a diagnosis has been made, patients will begin to work closely with pain specialists, therapists or psychiatrists and any other required specialists to treat both the physical and mental causes of their conditions.

Your medical team can help you determine which medications and therapies will best relieve the physical symptoms so that you and your therapist can work on the underlying mental issues that are causing or exacerbating the psychogenic pain. Possible ways to alleviate the physical pain include:

• getting physical therapy, especially when the muscles and joints are experiencing pain
• making dietary changes
• sticking to a healthy exercise regimen
• taking medication.

After the physical pain has been dealt with, patients are ready to seek their therapists or psychiatrists to pinpoint and work on their psychological disorder(s). Initially, these mental health specialists will construct a psychological profile that factors in your family medical history, your personal medical history and your lifestyle habits and choices. Then, over a series of session, you and your specialist will attempt to identify the sources and triggers of, as well as the treatment strategies for, your psychogenic pain.

Alternative treatment options for psychogenic pain include:

• acupuncture
• behavioral training
• family counseling
• hypnotherapy
• occupational therapy
• transcutaneous electrical nerve stimulation (TENS), the use of electrical nerve impulses to relieve pain.

While relieving the immediate physical pain is typically easy, treating the associated mental disorder takes far more work. Keep in mind that treating mental disorders often calls for long-term management, medication and therapy.

Without treatment, individuals suffering from psychogenic pain may undergo negative lifestyle changes, including:

• alcohol abuse
• drug abuse
• fatigue
• irritability
• isolation
• loss of sleep
• memory loss.

Resources

Lef.org (1995-2007). Chronic Pain. Retrieved August 28, 2007, from the Life Extension Foundation Web site: http://www.lef.org/protocols/health_concerns/chronic_pain_01.

htm.

Minddisorders.com (2007). Pain Disorder. Retrieved August 27, 2007, from the Encyclopedia of Mind Disorders Web site: http://www.minddisorders.com/Ob-Ps/Pain-disorder.html.

Va.gov (n.d.). Chronic Pain Primer. Retrieved August 28, 2007, from the United States Department of Veterans Affairs Web site: http://www1.va.gov/Pain_Management/page.cfm?pg=15.

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