Psychogenic pain refers to pain that is primarily caused or influenced by psychological and emotional factors, rather than originating in a physical injury or disease.
However, pain is a complex phenomenon that is influenced by biological, psychological, and social factors, and attributing it solely to psychological causes may oversimplify the condition and dismiss the physical aspects of pain. This type of pain can be distressing and can manifest in many ways. Psychogenic pain is not imaginary – it is experienced by the person – and can be challenging to diagnose as it doesn’t have a clear physical cause.
When it comes to children our concerns can vary, and psychogenic pain can be even harder to diagnose. However, through this article, you’ll learn more about psychogenic pain and hopefully will leave here more informed.
An overview of psychogenic pain
It is important to understand that psychogenic pain1 is real pain that is experienced and is not made up by someone; it is just caused by other factors that may not be specifically physical. The power of the mind is powerful, as well as our emotional state and emotional and life history. This is no different in children. In children, it is known as functional pain or pediatric somatic symptom disorder.
This type of pain can be real and distressing, but its origins are rooted in emotional or psychological issues rather than physical damage or dysfunction. It may be linked to psychological conditions like anxiety, depression, or stress, as well as unresolved emotional trauma or conflicts.
As medicine is moving to a more biopsychosocial model. The biopsychosocial model of pain emphasises the interaction of biological, psychological, and social factors in the experience of pain. Many experts advocate for using terms like "psychosocial factors in pain" to reflect this multidimensional understanding rather than implying that pain is purely psychogenic.
Causes of psychogenic pain can include the following:
- Stress and anxiety
- Depression
- Trauma, abuse, and emotional distress
- Family dynamics
- Personality factors
- Somatic symptom disorder
- Conversion disorder
- Childhood illness or injury
Although diagnosis is difficult and is something we’ll discuss shortly, some factors that are more readily recognisable if you know a child’s history such as family dynamics, trauma and emotional distress which can lead to a child having psychogenic pain. Children who have experienced trauma or abuse may develop psychogenic pain as a way of coping with their emotional distress.
Physical symptoms, including pain, may serve as a means of communicating their internal turmoil when they feel unable to do so verbally. Family dynamics play a significant role in the development of psychogenic pain in children. Dysfunctional family relationships, parental conflict, overprotectiveness, or high levels of parental stress can contribute to a child's emotional distress and physical symptoms.
Academic pressure, bullying, peer conflicts, or performance anxiety can lead to stress and psychological distress in children, which may manifest as psychogenic pain. Children may experience physical symptoms, such as headaches or stomach aches, in response to school-related stressors.
Children who have experienced chronic illness, injury, or medical procedures may develop psychogenic pain as a result of their experiences. The fear, anxiety, or traumatic memories associated with medical events can contribute to the development of psychogenic pain.
Although the causes can differ greatly, it is essential to know that the psychogenic pain that children experience is multifaceted and often can involve a combination of biological, social and psychological factors. Understanding these underlying factors is crucial for helping the child manage psychogenic pain through appropriate care and interventions.
Holistic diagnosis
Diagnosis can be challenging due to the complexity and overlap of other medical conditions. However, there are trained healthcare professionals who can help identify factors that are potentially creating or contributing to a child’s psychogenic pain.
Diagnosis typically begins with a comprehensive medical evaluation from a doctor to rule out any underlying physical causes of a child’s pain. Usually, this involves a medical history review, physical exams, and possibly other tests and imaging. In addition, or after the doctor has not found the causes of the pain, a psychosocial assessment may be done.
Psychosocial assessments are essential to understand a child’s emotional well-being, social environment, and family dynamics, and find any other causes that may be contributing to the pain. This psychosocial assessment may entail interviewing the parents of the child and can involve questionnaires and observations of a child’s behaviour.
Healthcare providers should explore potential psychological factors to a child’s pain such as stress, anxiety, or trauma, and possibly any unresolved emotional issues. Collaboration with a mental health professional such as a child psychologist2, therapist or psychiatrist may be necessary if a primary care doctor or paediatrician is unable to find initially a physical cause of a child’s pain. It is essential to have a holistic strategy.
In complex cases or when there is uncertainty about the diagnosis, consultation with a multidisciplinary team of healthcare professionals, including pediatric pain specialists, psychologists, physical therapists, and social workers, may be beneficial as well. This collaborative approach can provide a comprehensive assessment and guide treatment planning.
Treatment is multidisciplinary just like diagnosis. The goal of treatment is to reduce pain and enhance a child’s well-being and functioning.
Common approaches to treating psychogenic pain include:
- Cognitive-Behavioural Therapy (CBT)3 which is a structured therapy approach that can help a child develop awareness about their beliefs and thoughts and help them with coping strategies which can help to manage their pain and also help with learning behavioural techniques to reduce pain
- Biofeedback4: Using electronic monitoring devices to teach children how to respond to physiological sensations such as heart rate, skin temperature, and muscle tension
- Physical therapy
- Medication
- Family therapy
- School intervention
Treatment requires an individualized approach that addresses the child’s unique environment, both external and internal. This can include social factors or the complex interdependence between biological and psychological factors.
By integrating various therapeutic modalities and involving the child, family, and healthcare team in treatment planning, it is possible to effectively manage psychogenic pain and improve the child's quality of life.
FAQs
What is psychogenic pain in children?
Psychogenic pain in children refers to pain experienced by children that is influenced by psychological or emotional factors rather than solely by physical injury or disease.
Is psychogenic pain in children real?
Absolutely, psychogenic pain in children is real and can significantly impact their quality of life. While the underlying causes may be psychological, the pain experience is genuine and requires appropriate assessment and treatment.
What are the common causes of psychogenic pain in children?
Common causes of psychogenic pain in children include stress, anxiety, depression, trauma, unresolved emotional distress, family dynamics, and school-related stressors.
What are the typical symptoms of psychogenic pain in children?
Psychogenic pain in children can manifest as headaches, stomachaches, limb pain, muscle tension, or generalized bodily discomfort. These symptoms may vary in intensity and duration.
How is psychogenic pain in children diagnosed?
Diagnosis of psychogenic pain in children involves a comprehensive evaluation that includes medical assessment to rule out physical causes, psychosocial assessment to identify psychological factors, pain assessment using validated tools, and collaboration with mental health professionals.
How is psychogenic pain in children treated?
Treatment of psychogenic pain in children often involves a multidisciplinary approach that includes psychoeducation, cognitive-behavioural therapy (CBT), relaxation techniques, family therapy, physical therapy, medication management (if necessary), and school interventions.
Summary
In conclusion, psychogenic pain arises often from an interplay of psychological, social, and biological factors. As such, it can be quite difficult to diagnose, and treatment and diagnosis requires a comprehensive approach. This comprehensive approach can include various medical professionals such as a doctor, child psychologist, psychiatrist, or physical therapist. A comprehensive approach must be taken as the causes of psychogenic pain can vary.
Understanding the unique manifestation of psychogenic pain in children such as anxiety, trauma, stress, school life, and family dynamics is essential in the management of a child’s psychogenic pain.
Ongoing research and clinical advancements are needed to further understand the mechanisms underlying psychogenic pain in children. However, by incorporating supportive interventions as well as exploratory diagnosis through medical doctors and other professionals such as child psychologists, holistic care can be achieved.
References
- Danilov, A. B., et al. “[Psychogenic pain].” Zhurnal Nevrologii I Psikhiatrii Imeni S.S. Korsakova, vol. 118, no. 11, 2018, pp. 103–08. PubMed, https://doi.org/10.17116/jnevro2018118111103.
- “Child Psychologist: What They Do & Training.” Cleveland Clinic, https://my.clevelandclinic.org/health/articles/22666-child-psychologist. Accessed 2 Apr. 2024.
- “What Is Cognitive Behavioral Therapy?” Https://Www.Apa.Org, https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral. Accessed 2 Apr. 2024.
- De La Barra Ortiz, Hernán Andrés, et al. “Efficacy of Biofeedback in Rehabilitation of Musculoskeletal Disorders: A Systematic Review.” Advances in Rehabilitation, vol. 36, no. 1, 2022, pp. 41–69. DOI.org (Crossref), https://doi.org/10.5114/areh.2022.113241.