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ALL IN THE MIND by: Dr. Luz Dayrit, PT,DPT

Pain is an unpleasant sensation created by the brain to warn the body of an occurring injury. But it is possible that the mind itself fabricates the pain despite the absence of any real threat in the human body. This is referred to as psychogenic or psychosomatic pain. Psychogenic pain is an experienced physical pain arising from emotions and stress which is not attributable to any organic, anatomic and physiologic cause.

David Williams, PhD, in his manuscript (https://www.ncbi.nlm.nih.gov/pubmed/24080806), emphasized the importance of psychological assessment in pain management. There are two types of pain according to duration. Acute pain typically occurs in response to an injury and remains localized to the site of damage. On the other hand, chronic pain is a persistent pain and is often diffused. It commonly presents as a headache, muscle ache, stomach, upper or lower back pain. It is often accompanied by other comorbid symptoms that could add up to the individual’s discomfort. According to the same study, reduced physical functioning, sleep difficulties, fatigue and cognitive problems such as those with concentration and memory are among the most commonly reported comorbid symptoms.

The European Journal of Pain (https://deepblue.lib.umich.edu/bitstream/handle/2027.42/90300/j.ejpain.2004.11.001.pdf?sequence=1) asserted that brain activity for pain in chronic conditions is different in that of acute pain. When pain becomes chronic, sensory input from the body plays a reduced role while cognitive and affective pathways play a more important role in the formation of these pain signals. This meant that we respond more to the mind than the body during long-standing pain.



A number of options are available for the management of this type of pain. A study published in the Journal of the Association of Physicians of India (http://www.japi.org/february_2015_special_issue_pain/07_psychogenic_pain_disorder_different.pdf) enumerated possible interventions. The goals of the treatment are to decrease the pain and increase the quality of life. Pharmacological intervention may be included, if deemed necessary by a healthcare provider. Physical therapy is also an option. But most importantly, the emotional cause should be identified and then addressed afterwards.

Complementary and Alternative treatments are now being used to address different types of pain. These includes but not limited to meditation, yoga, massage, assisted stretching, and Fesiotherapy. The National center for complementary and Integrative health discuss more about these treatments at https://nccih.nih.gov/.

It is important to note that each individual may respond differently to different treatments. Most of the time, different techniques complement with each other for improve outcomes. Sometimes, several combinations of treatment maybe attempted prior to relief.

We add caution that not all pain is in the mind. The diagnosis of psychosomatic pain is made only after the exclusion of all the other possible causes. In fact, most of the pain felt is due to a real underlying reason which may require medical intervention. But, consider a psychogenic cause as a possibility, especially for relentless chronic pain that even intensifies and prolongs during stressful events. So, as much as possible, create a stress free environment for your body and mind. Declutter your head. Tame your thoughts. Maybe a positive mental health is all you need to relieve you from that tenacious discomfort.