by Raj N. Sureja, MD
My partner Jenny Andrus, MD and I have been writing about the differences between acute and chronic pain and the terms used to describe the origination of pain, nociceptive and neuropathic pain. We are doing this to help our readers better understand pain and to provide some insight into this often complex issue. One other type of pain that is important to describe is “Idiopathic Pain” – pain that has no specific or determinable cause or which has multiple etiologies, meaning the causes may be biological, physiological, psychological, psycho-social or any combination of these.
In the not too distant past, when patients complained of pain for which there was no clinical explanation, often they were written off as the pain being “all in their head”, and told to see a psychiatrist or to quit complaining and just deal with it. Now we know that the source of all pain originates in the brain, which interprets pain signals from nerves. We also understand that modern medicine cannot fully describe the complex workings of the brain or of pain mechanisms. With the evolution of our understanding of the sometimes unknown origins of pain, we have given it a category unto itself.
However, even with this knowledge, Idiopathic pain can be under-treated or not treated at all. Those who suffer from it may be accused of drug-seeking or of having some ulterior motive. They may not get the support that they need from loved-ones or friends who tell them that they don’t “look sick” or that there seems to be “nothing wrong”. This may result in feelings of depression which can certainly further complicate the pain picture. Unless they are seen by a physician specializing in the treatment of pain, they may still find the path to relief full of obstacles.
Because many physicians don’t fully understand these complex problems, they have developed terms that “define” the symptoms the patient reports. Migraine headaches, fibromyalgia, temperomandibular joint disorder, irritable bowel syndrome, myofascial pain syndrome…the list goes on and on. Unfortunately, there is a stigma associated with many of these classifications, going back to “it’s all in your head” diagnosis. How do we help these patients get the relief they need?
I see people who suffer from idiopathic pain in my practice. They are often frustrated and angry about the ways they have been treated by other healthcare providers and feel resentment about it. I try to offer them the support that has been lacking and instill in them a belief that I will do whatever I can to help them, that isn’t harmful to them or others.
Oftentimes, it is a process of trial and error, finding what doesn’t work and what provides relief. A complete history and physical of the patient helps. Even though we don’t know the cause of the pain, I can utilize an array of proven pain treatments, such as anti-inflammatory, anti-convulsant, anti-depressant and nerve medications, physical therapy, psychotherapy and interventional procedures. I can also recommend nutritional counseling, massage, exercise regimens, chiropractic care and biofeedback, to help the patient find a better quality of life.