No Medical Explanation for Your Pain?


By Derrick Schull, ND


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 listen- ing. It turns out, there is quite the debate in the scientifi c community on whether PPD is real or not.


P


sychogenic Pain Disorder (PPD) refers to a person experiencing pain with no medical explanations for the pain. It has other names such as “Pain somatization disorder.”


primate studies researchers conditioned monkeys to expect a painful stimulus 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.


If there is an


incentive to be in pain, then pain is experienced worse


Psychological Response to Pain is Normal Often when someone is experiencing pain, it is accompanied by


psychological complaints such as depression, anxiety, demoraliza- tion, 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 un- comfortable it makes us psychologically miserable. In this case, once the pain is removed, the psychological aspects should vanish as well. Therefore, this is not what we are talking about with PPD. In PPD, pa- tients 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


28 ELM® Maine - September/October 2019


We also have research that shows when experi- mental subjects watch something that induces fear, excitement, or other intense emotions, 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 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


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 consultations 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-


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36