Treatment for ‘Medically Unexplained’ Pain

‘Medically unexplained pain’ is a commonly used term to describe pain where the patient has no obvious biomarkers (scans, blood tests and other medical tests) that would explain their symptoms. Adhering to a strictly medial model to explain patient’s symptoms is limiting and consistently fails to explain the following observations.

We know that as pain becomes more chronic, its connection with any prior injury becomes weaker; the reasonable assumption is that, as tissues heal after an injury, there is normally a matching decrease and then cessation of acute pain that mirrors this. With chronic pain this does not happen for various reasons.

Patients who have quite debilitating pain often have no signs of disease at all. For example, patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS) have no obvious biomarkers - no evidence of inflammation, tissue damage or disease and normal looking scans, x-rays, blood tests, nerve conduction studies and other medical tests.

Conditions such as osteoarthritis and other so-called ‘degenerative diseases’ like changes to spinal discs are common in asymptomatic populations not just patients with pain. This indicates that these changes are not directly responsible for pain, at least not on their own.

Placebo analgesia is a very powerful phenomenon; patients feel significant pain relief with ‘sham’ treatments including medication, injections and even surgery.

It is not possible to reconcile the experience of ‘phantom’ pain, where a removed body part produces real ongoing pain, with the view that pain is just caused by damage to tissues.

People are often asymptomatic and yet have quite obvious signs of pathology when investigated. This is not just the case with pain but also diseases such as Parkinson’s where, for example, an autopsy of a completely asymptomatic individual discovers the same brain disease as you would find in people with quite marked symptoms of this neurological condition.

This can be quite frustrating for patients who trust in their practitioners to try and find something ‘wrong’ with them, to provide an explanation for their suffering and an opportunity to somehow fix the things that have gone wrong. We encourage our patients to gain a fresh perspective on why they may be feeling pain so that they consider not just structural and physiological changes in the body, most of which are entirely normal, but also how the autonomic nervous system, immune system, chemical changes in the central nervous system, disturbed sleep patterns, emotions and difficulties with mental wellbeing all affect how we feel. We call this the biopsychosocial model and it allows patients to explore other possibilities for change rather than persisting on looking at it from a single viewpoint, one that they are already frustrated with.