Psychogenic Pain

What is psychogenic pain?

“Psychogenic pain” is an outdated term for pain that doesn’t happen directly because of an injury or illness affecting your body. Instead, this form of pain originates in your brain and happens because of a combination of factors, including mental health, personal history and circumstances, other health conditions and more.

“Psychogenic” comes from two Greek words that, when combined, mean “produced in the mind.” In years past, people often believed that the term meant others viewed the pain as imaginary or that it only existed in someone’s head. That caused many people to feel invalidated, ignored, patronized or worse.

Healthcare providers no longer use this term because of that negative history. They also avoid it because the term is easy to misunderstand or misuse, which can cause confusion and undermine the relationship between people and their healthcare providers.

While psychogenic pain may not have a direct physical cause, this pain is still real. People who have this aren’t faking, lying or seeking attention. This pain feels the same — and involves part of the same processes — as pain from an injury or illness.

What is pain?

Understanding pain and how it works is a key part of how healthcare providers diagnose medical conditions. It can also help people better describe their pain to a provider while seeking help with a health issue. To understand how pain works, it helps first to know about how your nervous system functions.

Your brain has no nerve endings of its own and has no direct knowledge of the world around you. That’s why you have senses like vision, hearing, smell, taste and touch. A stimulus (pronounced “stim-you-luss,” and the word for more than one stimulus is “stimuli”) is anything your senses — including vision, hearing, smell, taste and touch — can detect.

Your body has a specific process for detecting and reacting to harm. That process works like so:

1. Noxious stimuli (from the Latin word “noxa,” which means “hurt” or “injury”) cause damage to cells of your body. That damage triggers the release of special chemicals into the surrounding tissue.
2. Your nervous system has specialized receptors called “nociceptors.” These work like smoke alarms in your home, detecting signs of a problem and sounding a warning immediately. When nociceptors detect the released chemicals from damaged or destroyed cells, they immediately send high-priority signals to your brain, alerting it to the problem. The signals they send aren’t pain itself.
3. Your brain receives these high-priority signals and translates them into the feeling of pain. Your brain also maps that feeling to the area that first sent the signals, so you know where the problem is.
4. The feeling of pain triggers immediate reactions in your brain and body. Those reactions are usually protective, such as triggering reflex muscle movements to move you away from whatever the noxious stimuli might be. Nociceptors also trigger immune and repair processes in your body to help protect you from infections and recover from injuries you might receive.

However, you can still feel pain even without nociceptor signals. That’s because your brain can still create the sensation of pain without those signals. Nociceptors can also activate on their own, creating the feeling of pain even when there’s no actual cause. In either of these two circumstances, the pain is real. It simply happens because of malfunctions in your brain or nervous system.

Perception of pain

Pain is subjective, meaning how you experience pain is unique, and nobody else experiences it the same way you do. One person might find an experience unbearably painful, while another person might find the same experience only slightly uncomfortable. Many factors, including genetic mutations, medical conditions and more, can affect how a person feels pain. Even a person’s state of mind can make pain feel better or worse.

As people age and deal with injuries, illnesses and different causes of pain, how they experience pain also changes. An example of this would be a child’s reaction when getting a shot compared to how adults react in that situation. However, chronic pain can also change the way a person feels pain, making pain more frequent or more intense.

Why pain is important

Pain is usually a protective process, especially when it tells you that you have an injury or something is happening to part of your body that could cause one. It’s also a key symptom that tells you when you’re sick, helping you act to take care of yourself or seek medical attention.

However, pain can also cause problems of its own when it’s very severe or when it lasts for a long period. Over time, chronic pain changes how your nervous system creates and handles pain signals. That can make nociceptors fire too easily, making pain more frequent or more intense, which can lead to disorders such as:

• Allodynia.
• Central pain syndrome.
• Hyperalgesia.

Pain and mental health

Your physical and mental health are intricately linked in ways that experts and researchers still don't fully understand. However, they do know that the two are linked and the link goes both ways. That’s why feeling anxiety can also make you feel queasy or nauseated, or feeling fear can cause a sinking feeling in your belly. Pain is no exception to that, as it can negatively affect your mental health, and your mental health can affect the way you experience pain.

What are the most common causes of psychogenic pain?

The term “psychogenic pain” once described pain that originated in the brain because of a mental health issue. The term fell out of use because researchers and experts realized that pain doesn’t have a single cause or factor influencing it. Instead, it happens because of a combination of factors.

These factors can be things that are happening right now, or things that happened years — or even decades — in the past. That’s also why pain can vary so widely and why everyone experiences pain in a way that’s totally unique to them.

It’s also important to keep in mind that how you experience pain changes over the course of your life. An example would be getting a vaccination as a child compared to getting a shot as an adult. As a child, getting a shot can feel much scarier, but adults can (usually) suppress that and deal with the pain of an injection.

The following factors can play a role in why you feel pain and how it affects you:

• Your body’s physical makeup and status: This includes all the factors that affect your body’s ability to feel pain. It also includes whether or not you’ve experienced an injury — either recently or far in the past — that affects how you feel pain today.
• Your environment: Where you are and what’s happening around you can play a big role in how you feel pain. If you’re in a place or a situation where you expect to feel pain, your brain actually intensifies the level of pain you feel.
• Your memories and experiences:Your brain has built-in processes that make learning easier. That’s why rewards (which people associate with good feelings) and punishments (which people associate with bad feelings) are so useful in teaching and learning. One of the ways your brain learns to avoid pain is by directly connecting it with negative feelings.
• Your mental state: How you regulate your emotions plays a major part in how you feel pain. As mentioned immediately above, negative emotions and pain rely on the same parts of the brain (or at least areas with strong connections). When you’re sad, anxious or depressed, those areas of your brain are already more active. That means it’s easier to feel pain, and the pain can also feel more intense. Pain is also easier to ignore when you have a distraction.
• Social factors:Your social background, upbringing, whether or not you had any childhood trauma and other factors can all affect how you feel pain. That’s because these can positively or negatively affect every one of the other factors listed above.

How pain and other factors add up

The factors that can contribute to or cause pain, including those listed above, are cumulative. That means they add up over time. The more factors that pile on, the greater the risk that a person’s pain processes will change, making them more susceptible to chronic pain, or for mental health issues and factors to make their pain more severe.

For example, a person who grew up in poverty, didn't have strong support systems or had childhood trauma has a higher risk of experiencing chronic pain. The stress — physical, mental and otherwise — takes a toll. For these individuals, pain can happen more easily and feel more severe. It’s also more likely that mental health issues and factors can influence their pain and make it worse.

How is psychogenic pain treated?

Just as experts and healthcare providers no longer use the term “psychogenic pain,” they also no longer treat pain the same way as they once did. Today, treating pain involves treating the whole person, including the emotional, behavioral and social components of pain. Sometimes, when individuals have chronic pain, they may also have an underlying mental health condition that requires treatment, too.

The psychological treatment of pain can involve the following:

• Cognitive behavioral therapy (CBT): This is the most common type of psychotherapy (mental health therapy) recommended. Experts also consider it the most likely to work.
• Group therapy: Shared therapy experiences can help people with chronic pain. Group therapy can help people with this condition connect with others who have similar struggles and exchange ideas, resources and knowledge.
• Other forms of therapy:Examples include acceptance and commitment therapy, mindfulness therapy or even hypnotherapy.

Other treatments that may help include:

• Physical therapy: Psychogenic pain can cause physical effects. Physical therapy can help people with this issue recover from or adapt to the physical symptoms.
• Medication: When psychogenic pain happens alongside other conditions, such as depression or anxiety, medications for those conditions can help pain symptoms also. Because of that, many antidepressants can often positively affect pain levels.
• Other treatments and management techniques:Examples include a wide range of approaches and practices. Just a few of these include meditation, mindfulness, acupuncture, physical activity, etc.

Many other treatments and options may also help you. Your healthcare provider is the best person to tell you what kind of options are available and what you can do to help yourself, too.

What can I do at home to treat pain?

Even when pain doesn’t happen because of nociception, it still involves part of the same pain process. That means this pain is real and feels exactly like pain that starts with nociception, so there’s no way to tell what’s causing it or what factors are contributing to it. Because of this, you should see a healthcare provider when you have moderate or severe pain that doesn’t respond to at-home treatments or lasts for extended periods.

Is this type of pain preventable, and can I reduce my risk of developing it?

Pain happens unpredictably and in ways that are different from one person to another. Because of that, there’s no way to completely avoid changes in how you feel pain because of mental health factors, your personal history and circumstances, etc.

When should pain be treated by a doctor or healthcare provider?

When you have chronic pain or suspect that you have pain that’s worse due to mental health concerns and other factors, you should see a healthcare provider for diagnosis or treatment. The reasons why include:

• Trying to self-treat this condition is often unsuccessful because it doesn’t involve the same processes as pain from a medical condition or injury. That means it doesn’t respond to pain as medical conditions or injuries ordinarily would.
• Trying to self-medicate with over-the-counter medications is unlikely to work. Self-medicating with alcohol, prescription medications or recreational drugs is even riskier and can lead to substance use disorders, addictions and other severe consequences. Because of all these factors, a healthcare provider should always guide the treatment of psychogenic pain.
• Chronic pain can change how your body feels and processes pain, especially at moderate and severe levels. It also can worsen existing problems like anxiety or depression.

What does psychogenic pain feel like, and how can you tell if pain is psychogenic?

Pain can take many different forms. Even when pain happens without nociception, your brain still processes it the same way. That means it can feel exactly like any kind of pain you can feel, whether it be back pain, abdominal pain, chest pain, etc.

The only way to tell the difference is for a trained, qualified healthcare provider to evaluate and diagnose this problem. That diagnosis also involves a combination of methods, including diagnostic tests, imaging scans, lab tests, a neurological exam and more.

Is psychogenic pain serious?

Even when pain isn’t severe, it can still be a serious problem. Over time, chronic pain can seriously impact your health and well-being. In addition to how pain changes the way your nervous system functions, it can take a toll on your mental health in other ways. Anxiety and depression are common complications of chronic pain. All these factors combined mean chronic pain is ultimately serious over time and needs diagnosis and treatment.

A note from Cleveland Clinic

“Psychogenic pain” is an outdated term that healthcare providers no longer use. This term once described pain that happens when your body’s pain processes work incorrectly, activating because of a mental health condition that disrupts the way your nervous system works. Today, experts know that pain involves many processes and factors. While it might not happen for a specific physical reason, the pain is real and feels no different from pain from an injury or illness.

This term fell out of use because of misunderstandings over its meaning and the potential for people to feel ignored or invalidated. Today, healthcare providers refer to this as one of the symptoms of functional neurological symptoms disorder. With diagnosis and treatment, it’s possible to manage and reduce the effects of many forms of pain, regardless of the contributing factors.