Psychogenic Pain—What It Means, Why It Does Not Exist, and How to Diagnose It

The concept of psychogenic pain has stimulated controversy in the field of pain medicine, not only regarding its prevalence, but indeed its very existence. Some would even hold that the term is fundamentally meaningless. Whether meaningless or not, it is often hated—by physicians in pain medicine whose patients have been harmed by not having been taken seriously, and by patients who experience the unspoken judgment that, “since there's nothing wrong with your body, there must be something wrong with you. ”Although this appears to be a question of fact, our recent presidential election demonstrates that interpretations of events are subject to distortion by biases, and there is a surfeit of bias surrounding the question of psychogenic pain.The IASP defines pain as an experience, and it could be concluded that, since all experiences are psychological phenomena, the term psychogenic pain is a meaningless tautology, much like psychogenic joy. Pain has even been called “a localized form of sorrow” by Spinoza. The acknowledged duality of pain—the fact that it is both sensation and emotion—is reflected in anatomy and physiology. Its affective components may transit the spinoreticular tracts en route to the anterior cingulate cortex, while its algosity, to borrow a term [1], may traverse the spinothalamic tracts toward the sensory cortex. Yet this emotional part of pain does not resolve the question. One could argue that every thought, emotion, and fantasy is at some level a neurochemical event, so that everything is ultimately “organic,” i.e., not psychogenic. Nevertheless, it may be useful to explore the concept to determine whether it has value.Perhaps the biases should be addressed first, since they affect perception. You have to believe it to see it, as it were.The imperative that physicians work on behalf of their patients leads naturally to a desire …