When Stress Hurts: Psychogenic Pain

PendulumThis post kicks off a Stresshacker series on the close association between psychological stress and psychogenic pain. Psychogenic pain is by definition a physical pain that can only be associated with psychological stressors. Psychogenic pain is said to occur when all possible organic causes of pain are ruled out and its symptoms cannot be associated with a medically diagnosed condition. There can be a stigma associated with this type of pain as being “all in one’s head,” and the suffering it causes has often been discounted or dismissed as unexplainable and therefore not treatable with conventional medical approaches.

I’m 23, and have had chronic pain since I was in middle school. Doctors always brushed it off, saying it was "growing pains" or "all in my head." About two years ago, I was given the diagnosis of fibromyalgia. I felt like that doctor visit was a waste of time. I certainly do believe that fibromyalgia is a real condition, but that was not what was wrong with me. Doctors are quick to throw some label on patients to placate them… — Mrs. Smith of SC @ Aug 21, 2010 21:20:28 PM

Pain, of any kind, is a complex peripheral and central nervous phenomenon that acts as a signaling mechanism, usually indicating the presence of injury or disease. The International Association for the Study of Pain (IASP) defines pain as, “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is more than just physical since, like all human experiences, it includes a cognitive and emotional component.

spinozaThe 17th century philosopher Spinoza recognized the emotional and physical valence of pain when he defined it as a “localized form of sorrow.” This definition is particularly appropriate when pain is present in all its debilitating intensity and does not appear to be a sign of injury or a diagnosable illness.

The persistence of unexplained pain to shoulders, upper arms, lower arms, hips, upper legs, lower legs, jaw, chest, neck, or abdomen can lead to a diagnosis of fibromyalgia especially if associated with other symptoms such as irritable bowel syndrome, fatigue, anger and sadness, problems thinking or remembering, muscle weakness, abdominal pain or cramping, numbness or tingling, dizziness, insomnia, depression, constipation, nausea, nervousness, chest pain, fever, dry mouth, itching, frequent or painful urination, or wheezing. Treatment for fibromyalgia can range from powerful prescription pain killers (which can be dangerously addictive) to gentler and often as efficacious non-medical approaches such as psychotherapy and tai chi.

That a reciprocal association exists between psychological stress and unexplained pain symptoms has long been observed in clinical settings. A significant number of patients suffering from psychogenic pain also complain of stress, often made worse by other psychological disturbances such as depression or anxiety disorders.

A review of recent medical literature on pain and stress yields strong evidence for increased sensitivity to stress in patients with psychogenic pain, and vice versa. Studies conducted in the last decade suggest that psychogenic pain and stress are psychological and sensory experiences that require a multidisciplinary, biopsychosocial approach in their treatment.

Next in this series:

  • Psychogenic Pain, Stress and the Central Nervous System
  • The Neurochemistry of Psychogenic Pain and Stress
  • Psychological Stressors and the Sudden Appearance of Psychogenic Pain
  • Fibromyalgia, Severe Headaches and Other Stress-Related Misery
  • Medical and Non-Medical Treatments for Stress and Psychogenic Pain