Psychogenic pain

Last updated
Psychogenic pain
Other namesNociplastic pain [1]
Specialty Psychiatry

Psychogenic pain is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors, without evidence of physical injury or illness. [2] [3] [4]

Contents

Headache, back pain, or stomach pain are some of the most common types of psychogenic pain. [5] It is commonly accompanied by social rejection, broken heart, grief, lovesickness, regret, or other such emotional events. This pain can also be caused by psychological disorders such as anxiety and depression, which can affect the onset and severity of pain experienced.

The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." This definition was revised for the first time since 1979 in 2020, and was officially published in the ICD-11. The IASP broadens this definition to include psychogenic pain with the following points:

Furthermore, the ICD-11 removed the previous classification for psychogenic pain (persistent somatoform pain disorder) from the handbook in favor of understanding pain as a combination of physical and psychosocial factors. This is reflected in the definition for chronic primary pain, which acknowledges that pain stems from multiple personal and environmental factors and should be diagnosed "independently of identified biological or psychological contributors." [7]

Some specialists believe that psychogenic chronic pain exists as a protective distraction to keep dangerous repressed emotions such as anger or rage unconscious. It remains controversial, however, that chronic pain might arise purely from emotional causes. [8]

Diagnosis

There is no specific way of testing for psychogenic pain making it difficult to assess. There are many different criteria and factors considered for psychogenic pain diagnosis.

Treatment

For many patients a combination of psychotherapy and pharmacotherapy can help to alleviate or treat the symptoms of psychogenic pain. These treatments can include cognitive behavioral therapy, acceptance and commitment therapy, or forms commonly used for chronic pain treatments. Interventional techniques can also be used. [9] Treatments can address underlying feelings and emotional conflicts that can lead to psychogenic pain, as well as other potential causes of dysfunction with behavior, affect, and coping that can be seen in patients. [10] In cases where therapy and medication do not show results, some may consider surgical intervention. These surgeries target portions of the brain associated with mood disorders and pain. Deep brain stimulation (DBS) is another possible treatment that works by stimulating parts of the brain related to behavior and emotion to relieve the psychological cause of the pain. [9]

Controversy

The term "psychogenic pain" has begun to fall out of relevance in the scientific community, due to its implication that the pain is entirely psychological in origin and thus not "real". [11] The change in preferred nomenclature can be traced to 1994 when the DSM-IV removed the term in favor of the more holistic "Pain Disorder" section. [4] The ICD-11 made a similar change, as mentioned above. It is important to note that this change is not universal, and is mostly confined to the English-speaking medical community. The term psychogenic pain is still used in non-English literature. [9]

To fill the new gap in terminology left by the declining use of psychogenic pain, the term "nociplastic pain" was coined in 2016. [12] Nociplastic pain is defined as chronic pain that cannot be classified as nociceptive (pain caused by the activation of nociceptors) or neuropathic (pain caused by damage to the nervous system). Nociplastic pain is functionally defined in one article as "pain arising from the altered function of pain-related sensory pathways in the periphery and CNS (Central Nervous System)",and, unlike psychogenic pain, can be diagnosed in conjunction with other types of pain. [12] [13]

See also

Related Research Articles

Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, behavioral factors on bodily processes and quality of life in humans and animals.

Chronic pain or chronic pain syndrome is a type of pain that is also known by other titles such as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is sometimes confused with acute pain and can last from three months to several years; various diagnostic manuals such as DSM-5 and ICD-11 have proposed several definitions of chronic pain, but the accepted definition is that it is "pain that lasts longer than the expected period of recovery."

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome that causes chronic widespread pain, accompanied by fatigue, awakening unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and some infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome". Although a protocol using an algometer (algesiometer) for determining central sensitization has been proposed as an objective diagnostic test, fibromyalgia continues to be primarily diagnosed by exclusion despite the high possibility of misdiagnosis.

Conversion disorder (CD), or functional neurologic symptom disorder (FNsD), is a functional disorder that causes abnormal sensory experiences and movement problems during periods of high psychological stress. Individuals with CD present with highly distressing neurological symptoms such as numbness, blindness, paralysis, or convulsions, which are not consistent with a well-established organic cause and can be traced back to a psychological trigger.

Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity and motility disturbances.

Pain disorder is chronic pain experienced by a patient in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

<span class="mw-page-title-main">Primary polydipsia</span> Medical condition

Primary polydipsia and psychogenic polydipsia are forms of polydipsia characterised by excessive fluid intake in the absence of physiological stimuli to drink. Psychogenic polydipsia caused by psychiatric disorders—oftentimes schizophrenia—is frequently accompanied by the sensation of dry mouth. Some conditions with polydipsia as a symptom are non-psychogenic. Primary polydipsia is a diagnosis of exclusion.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.

Classified as a "conversion disorder" by the DSM-IV, a psychogenic disease is a condition in which mental stressors cause physical symptoms matching other disorders. The manifestation of physical symptoms without biologically identifiable cause results from disruptions in normal brain function due to psychological stress. During a psychogenic episode, neuroimaging has shown that neural circuits affecting functions such as emotion, executive functioning, perception, movement, and volition are inhibited. These disruptions become strong enough to prevent the brain from voluntarily allowing certain actions. When the brain is unable to signal to the body to perform an action voluntarily, physical symptoms of a disorder arise. Examples of diseases that are deemed to be psychogenic in origin include psychogenic seizures, psychogenic polydipsia, psychogenic tremor, and psychogenic pain.

<span class="mw-page-title-main">Neurological disorder</span> Any disorder of the nervous system

Neurological disorders represent a complex array of medical conditions that fundamentally disrupt the functioning of the nervous system. These disorders affect the brain, spinal cord, and nerve networks, presenting unique diagnosis, treatment, and patient care challenges. At their core, they represent disruptions to the intricate communication systems within the nervous system, stemming from genetic predispositions, environmental factors, infections, structural abnormalities, or degenerative processes.

Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.

Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

Atypical facial pain (AFP) is a type of chronic facial pain which does not fulfill any other diagnosis. There is no consensus as to a globally accepted definition, and there is even controversy as to whether the term should be continued to be used. Both the International Headache Society (IHS) and the International Association for the Study of Pain (IASP) have adopted the term persistent idiopathic facial pain (PIFP) to replace AFP. In the 2nd Edition of the International Classification of Headache Disorders (ICHD-2), PIFP is defined as "persistent facial pain that does not have the characteristics of the cranial neuralgias ... and is not attributed to another disorder." However, the term AFP continues to be used by the World Health Organization's 10th revision of the International Statistical Classification of Diseases and Related Health Problems and remains in general use by clinicians to refer to chronic facial pain that does not meet any diagnostic criteria and does not respond to most treatments.

<span class="mw-page-title-main">Orofacial pain</span> Pain of the mouth, jaws, or face

Orofacial pain (OFP) is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes.

Organic personality disorder (OPD) or secondary personality change, is a condition described in the ICD-10 and ICD-11 respectively. It is characterized by a significant personality change featuring abnormal behavior due to an underlying traumatic brain injury or another pathophysiological medical condition affecting the brain. Abnormal behavior can include but is not limited to apathy, paranoia and disinhibition.

Pain psychology is the study of psychological and behavioral processes in chronic pain. Pain psychology involves the implementation of treatments for chronic pain. Pain psychology can also be regarded as a branch of medical psychology, as many conditions associated with chronic pain have significant medical outcomes. Untreated pain or ineffective treatment of pain can result in symptoms of anxiety and depression, thus it is vital that appropriate pain management occur in a timely fashion following symptom onset.

<span class="mw-page-title-main">Nociplastic pain</span> Symptom

Nociplastic pain, also known as central sensitisation, is a third category of pain that is mechanistically distinct from nociceptive pain, which is due to inflammation and tissue damage, and neuropathic pain, which is due to nerve damage. It may occur in combination with the other types of pain or in isolation. Its location may be generalised or multifocal, and it can be more intense than would be expected from any associated physical cause.

References

  1. ↑ "Fitzcharles, Mary-Ann; Cohen, Steven P.; Clauw, Daniel J.; Littlejohn, Geoffrey; Usui, Chie; Häuser, Winfried (2021-05-29). "Nociplastic pain: towards an understanding of prevalent pain conditions". The Lancet. 397 (10289): 2098–2110. doi:10.1016/S0140-6736(21)00392-5. ISSN 0140-6736. PMID 34062144.
  2. ↑ "Psychogenic pain". Biology-Online Dictionary. 7 October 2019.
  3. ↑ "Psychogenic Pain: What It Is, Symptoms & Treatment". Cleveland Clinic. Retrieved 2023-03-04.
  4. 1 2 Doleys, Daniel M. (2014-02-01). "Psychogenic Pain: Is It a Useful Concept?". doi:10.1093/med/9780199331536.003.0007.{{cite journal}}: Cite journal requires |journal= (help)
  5. ↑ "Psychogenic & Psychological Pain&". Cleveland Clinic.
  6. ↑ "Terminology | International Association for the Study of Pain". International Association for the Study of Pain (IASP). Retrieved 2023-04-14.
  7. ↑ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 2023-04-14.
  8. ↑ Stephen Tyrer, Psychosomatic pain, The British Journal of Psychiatry (2006) 188: 91-93
  9. 1 2 3 4 Isagulyan, Emil D.; Makashova, Elizaveta S.; Myasnikova, Lyubov' K.; Sergeenko, Elizaveta V.; Aslakhanova, Karina S.; Tomskiy, Alexey A.; Voloshin, Alexey G.; Kashcheev, Alexey A. (2022-01-01), Chernov, Mikhail F.; Rzaev, Jamil A.; Martínez-Álvarez, Roberto (eds.), "Chapter 7 - Psychogenic (nociplastic) pain: Current state of diagnosis, treatment options, and potentials of neurosurgical management", Progress in Brain Research, Neurosurgical Management of Psychiatric Disorders, Part B, 272 (1), Elsevier: 105–123, doi:10.1016/bs.pbr.2022.03.008, ISBN   9780128237694, PMID   35667797 , retrieved 2022-10-09
  10. ↑ Wasan, Ajay D.; Alpay, Menekse (2008-01-01), Stern, Theodore A.; Rosenbaum, Jerrold F.; Fava, Maurizio; Biederman, Joseph (eds.), "CHAPTER 78 - Pain", Massachusetts General Hospital Comprehensive Clinical Psychiatry, Philadelphia: Mosby, pp. 1067–1079, ISBN   978-0-323-04743-2 , retrieved 2022-10-09
  11. ↑ "Psychogenic Pain: What It Is, Symptoms & Treatment". Cleveland Clinic. Retrieved 2023-02-05.
  12. 1 2 Fitzcharles, Mary-Ann; Cohen, Steven P.; Clauw, Daniel J.; Littlejohn, Geoffrey; Usui, Chie; Häuser, Winfried (2021-05-29). "Nociplastic pain: towards an understanding of prevalent pain conditions". The Lancet. 397 (10289): 2098–2110. doi:10.1016/S0140-6736(21)00392-5. ISSN   0140-6736. PMID   34062144. S2CID   235245552.
  13. ↑ Popkirov, Stoyan; Enax-Krumova, Elena K.; Mainka, Tina; Hoheisel, Matthias; Hausteiner-Wiehle, Constanze (2020-01-01). "Functional pain disorders – more than nociplastic pain". NeuroRehabilitation. 47 (3): 343–353. doi:10.3233/NRE-208007. ISSN   1053-8135. PMID   32986624. S2CID   222167524.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.