Psychogenic pain

Unless the patient has reasons for ‘malingering’ – the symptoms are simulated for compensation or litigation motives – pain is always indicative of some degree of dysfunction. In most instances, the dysfunction is physical. Sometimes, however, the pain is devoid of any organic basis. If the patient has an unconscious belief in the reality of the symptoms, a psychogenic disorder is likely. The pain is then labelled ‘inorganic’ or ‘functional’. There is an emotional illness and, although no peripheral tissue damage exists, the pain is as distressing as is somatic pain. Pain is often the outcome of a combination of physical and psychological causes. It is a highly complex phenomenon: psychological factors affect the way people experience and express pain; conversely, chronic pain often results in secondary personal difficulties. Because pain is an abnormal affective state (though called into being by physical changes in the body), a heightened awareness may increase the severity of the symptoms. The patient may then present with irrational complaints that obscure genuine factors. The detection of disorders which have their origin in the patient’s mind or from the desire to elicit sympathy or compensation is simple if the patient is examined by the methods set out in this book. However, it is more difficult to assess those who present with an organic lesion with psychogenic overlap. Here, much patience and clinical experience will be required to unravel the complicated clinical picture. Orthopaedic medicine and psychogenic pain