Volume 5 Issue 2 Feb 2015
Consultation- Liaison Psychiatry Focus: Pain
“Attending that session is a real headache”, “I am not calling him, he is such a pain!”
All of us use such phrases in our day to day language. Can a session give rise to headache or a person bring pain? If I ask this question to everyone reading this write up, I am certain to get “of course YES!” from majority of readers. Our subjective perception of bad/unpleasant/uncomfortable experiences can sometimes manifest in form of somatic complaints. Furthermore, the absence of any underlying organic disorder to explain the symptoms is essential for the label of ‘psychogenic’, which is hence, a diagnosis of exclusion, although not in all the cases.
Having established the existence of psychogenic pain in day to day situations, here we are not talking about the relatively ‘black and white’ type of entities commonly encountered among people with recognizable psychotic illness. Rather these are the complaints brought by people belonging to ‘apparently healthy’ population. There is a wide spectrum of presenting complaints from headaches to abdominal pain; it may be subtle or overt, acute or chronic, mild or disabling. The current therapeutic options, including symptomatic treatment agents like analgesics/antacids, psychological counseling and uncommonly, antidepressants are often not sufficient to bring the desired relief in a shorter period.
On one hand, missing a diagnosis may pose the patient to unnecessary expense and stress of investigations and treatment. On the other hand, over-diagnosis may sometimes lead to unlimited progression of undiagnosed illness like chronic infections or malignancies. It has to be a careful yet balanced approach with constant monitoring, re-evaluation and reconsideration to the diagnosis along follow up of such patients for their recovery.
As evident from published literature, there are countless loose ends about the evaluation, diagnosis and management of these conditions. Possible silent organic diseases, predictors of vulnerable personality traits and deflections in the threshold of perception of different stresses are some of the several areas open to exploration. I am sure that the curiosity among the upcoming clinical and research brigade will be able to find out reasonable answers to several of these questions.
Dr Bhanu Kiran Bhakhri, Assistant Professor of Pediatrics, AIIMS Rishikesh, Uttarakhand
