The myth of unexplained pain

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

'...pain might be considered a disease in its own right.'

Main

de C Williams A C. Fac Dent J 2011; 2: 148–151

The cover sheet for this 'OPINION' statement in an issue that focuses largely on pain, is enigmatic yet insightful. It is a diagram of a maze. Surely this illustrates the sometimes almost insurmountable difficulty that a physician may encounter in caring for a patient with unexplained pain. An inference that the pain is not real is unacceptable. The author, a psychologist, asserts that 'mysterious psychological phenomena' such as 'somatisation', 'medical unexplained' or 'functional' leads patients nowhere. Pain from an evolutionary perspective protects against injury and promotes healing. Such an approach is more useful than any psychological speculation. Nevertheless, with chronic as opposed to acute pain, there are 'shifts (in patients) towards more emotional and motivational involvement'. Importantly, when patients seek advice from their primary care physician, the patient focuses on the physical symptoms suppressing the emotional components of their pain.