(See also Overview of Pain Overview of Pain Pain is an unpleasant sensation signaling actual or possible injury. Pain is the most common reason people visit their doctor. Pain may be sharp or dull, intermittent or constant, or throbbing... read more .)
Psychologic factors can strongly influence how people perceive pain—particularly chronic pain Chronic Pain Chronic pain is pain that lasts or recurs for months or years. Usually, pain is considered chronic if it does one of the following: Lasts for more than 3 months Lasts for more than 1 month after... read more and sometimes pain-related disability. Almost all pain has some physical basis. But psychologic factors, including anxiety Overview of Anxiety Disorders Anxiety is a feeling of nervousness, worry, or unease that is a normal human experience. It is also present in a wide range of psychiatric disorders, including generalized anxiety disorder,... read more and depression Depression A short discussion of prolonged grief disorder. Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to... read more , may make people feel less able to control their symptoms and thus less able to do their normal activities. For example, people with chronic pain know the pain will recur, and they may become fearful and anxious as they anticipate the pain's return. When people understand that worsening pain may not indicate damage to their body, they may have less anxiety (for example, about deteriorating physically or losing function) and thus have less pain.
Rarely, people have persistent pain with evidence of psychologic disturbances and without evidence of a disorder that could account for the pain or its severity. This pain may be described as psychogenic. However, psychophysiologic pain is a more accurate term because the pain results from interaction of physical and psychologic factors. For example, fear and anxiety can reduce the production of substances that reduce the sensitivity of nerve cells to pain. This change in sensitivity to pain partly accounts for pain that persists after its cause resolves and for pain that feels more severe than expected. Psychogenic pain is far less common than nociceptive pain Nociceptive Pain Nociceptive pain is caused by an injury to body tissues. (See also Overview of Pain.) Most pain is nociceptive pain. It results from stimulation of pain receptors for tissue injury (nociceptors)... read more or neuropathic pain Neuropathic Pain Neuropathic pain is caused by damage to or dysfunction of the nerves, spinal cord, or brain. (See also Overview of Pain.) Neuropathic pain may result from Compression of a nerve—for example... read more .
The fact that pain is worsened by psychologic factors does not mean that it is not real. Most people who report pain are really experiencing it, even if a physical cause cannot be identified. Doctors always investigate whether a physical disorder is contributing to chronic pain but often do not find an adequate explanation for the pain.
Pain that is heavily influenced by psychologic factors requires treatment, often by a team that includes a psychologist or psychiatrist. Treatment for this type of pain varies from person to person, and doctors try to match the treatment with the person’s needs.
For most people who have chronic psychogenic pain, the goals of treatment are to improve comfort and physical and psychologic function.
Doctors may make specific recommendations for gradually increasing physical and social activities.
Drugs and nondrug treatments Nondrug Pain Treatments In some cases, treating the underlying disorder eliminates or minimizes the pain. For example, setting a broken bone in a cast or giving antibiotics for an infected joint helps reduce pain.... read more —such as biofeedback Biofeedback Biofeedback, a type of mind-body medicine, is a method of bringing unconscious biologic processes under conscious control. In biofeedback, electronic devices are used to measure and report information... read more , relaxation training, distraction techniques, hypnosis, transcutaneous electrical nerve stimulation In some cases, treating the underlying disorder eliminates or minimizes the pain. For example, setting a broken bone in a cast or giving antibiotics for an infected joint helps reduce pain.... read more (TENS), and physical therapy Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more —may be used. Many drugs that help relieve pain also help relieve insomnia, anxiety, and depression.
Psychologic counseling is often needed.