No Medical Explanation for Your Pain?


By Derrick Schull, ND P


sychogenic Pain Disorder (PPD) refers to a person experi- encing pain with no medical explanations for the pain. It has other names such as “Pain somatization disorder.” These terms essentially mean, “we can’t fi nd a reason for the pain so it is likely all in your head.” To many, this diagnosis can be quite off putting and offensive. No one wants to be told they are crazy and the pain is all in their head. Often, the referral of pain patients to psychological practitioners is taken as an assault or lack of validation, as if the doctor isn’t really listening. It turns out, there is quite the debate in the scientifi c community on whether PPD is real or not.


Psychological Response to Pain is Normal


Often when someone is experiencing pain, it is accompanied by psychological complaints such as depression, anxiety, demoralization, or irritability. We don’t have to look far to see there is a connec- tion between the two. One logical explanation is that pain is so uncomfortable it makes us psycholog- ically miserable. In this case, once the pain is removed, the psycholog- ical aspects should vanish as well. Therefore, this is not what we are talking about with PPD. In PPD, patients have pain and psychological complaints and there has not been any way to eliminate the pain, so the psych complaints persist.


Can Pain be Caused or Altered by Our Emotions or Other Factors?


Scientifi c studies have shown that people getting placebo pain treatments often feel the pain getting worse. Normally, pain would be experienced as the same or improved in accordance with standard placebo effects. This indicates that there is an expectation or psycho- logical cause behind the experience of pain. Other experiments have used dense sensory-motor blocks to stop extremity pain, to no effect. In these cases, the nerve is completely blockaded against sending a pain signal, yet the patient still experiences pain. In interesting primate studies researchers conditioned monkeys to expect a painful stimu- lus and saw their brains (with imaging techniques) creating a pain response before any pain stimulus was applied. Meaning they felt pain without any cause aside from they expected to feel pain.


We also have research that shows when experimental subjects


watch something that induces fear, excitement, or other intense emo- tions, the parts of their brain that process pain will become active. Furthermore, it is well understood that people who undergo extreme traumas will present with many symptoms, including pain, that have no physical explanation.


We can compare PPD to a similar disorder called “phantom


pain.” This is where amputees still feel pain in the part of their body that was removed. In these incidences, pain is being generated in the nervous system and has nothing to do with pain from the perceived source. Similarly, there is a theory called “pain memory” where the nervous system retains a pain signal long after the source has been


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healed. These both suggest that pain is legitimate, had an original source, but persists for some unknown reason. Could it be that PPD similarly had an original source, but the brain/nervous system has got- ten stuck in a pain signal loop?


It would also seem there is a big confounding factor when it If there is an


incentive to be in pain, then pain is experienced worse


comes to studying pain. A study on more than 2000 lower back pain patients found that all of those working at the time of initial pain con- sultations returned to work, with the exception of those in litigation, of whom not one returned to work. These patients have been shown to improve the same amount in pain programs, but still claimed no improvements in quality of life and higher rates of disability. In other words, if there is an incentive to be in pain, then pain is experienced worse. It is not clear if this is uninten- tional, or if there is in fact malingering/faking the pain to maximize re-imbursement. Studies on malingering show that between 1.25% and 10.4% of compensation claims have confi rmed misrepresentations of symp- toms. That means we cannot ignore that there are in fact people that are faking it, but this does not account


for the majority of chronic pain patients. As you can see, there is quite a web of factors contributing to pain


syndromes. From research, it seems reasonable to conclude that pain could in fact be caused by (or exacerbated by) psychological changes. There is clearly evidence supporting PPD as a diagnosis, but fi guring out if a patient is misdiagnosed, malingering, exaggerating their pain for sympathy and attention, or has a true psychogenic pain disorder can be a tall order. What’s important is that many people fi nd resolu- tion by exploring alternative methods.


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