THE PSYCHOLOGICAL APPROACH TO FUNCTIONAL PAIN: UNDERSTANDING THE CAUSE

One of the difficulties in the management of functional pain is that we find it very hard to accept the idea that the pain is in fact due to our nerves. We feel the pain; it hurts; it is a real pain. We are convinced in our mind that such real pain is not psychological in origin. We tell this to the doctor, but somehow he does not seem to understand. If he would only do some additional test we feel sure that it would show some organic cause for our trouble. We undoubtedly want to find an organic cause. Such is our scale of values that no one is very proud of himself when he has to explain to his friends that his pain is merely due to nerves. But there is more to it than this. The pain is so bad that we ourselves feel sure that it must be due to some physical condition of our body. This is particularly the case in psychosomatic abdominal pain. Our anxiety has affected the smooth working of our bowels. They contract in spasms, and often quite violently, and the part of the bowels in front of the contraction does not relax properly in the way that it should. The pain nerves in the bowels are stimulated and we experience real colic.

It is clear that the first step in the self-management of such a condition is the acceptance of the idea that the pain is in fact the result of our anxiety. By acceptance of the idea I do not just mean verbal agreement with our doctor. It is very easy to do this, and at the same time to keep our own reservations on the matter. No. We must accept the truth openly and without reservation.

There is a further point that needs explanation. We are often inclined to think that our pain should be directly related to the cause of our anxiety. For instance, if our anxiety is caused by a sexual conflict, as it often is, then we might expect it to show itself in pain in the sexual parts rather than in pain in the stomach. But this is not so. There are usually two factors: one is the conflict or conflicts which produce our anxiety; and the other is usually some incidental matter, such as past trouble in some organ, so that our attention is focused there in a way that has the effect of localizing our psychological pain in this part of the body.

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