Non-organic Pain

In our pain group sessions there are sometimes people who can barely participate or who say they cannot sit or stand with biomechanically correct posture because of pain. Although the postures we teach are those that put the least amount of stress on the neck, back and other parts of the body, these individuals persist with their own postures because the “correct” ones are too painful. I believe them.

However, it must be pointed out that the postures used by these patients are almost always ones that would lead to pain in most people. From a musculoskeletal point of view, sitting, standing or walking the way they do is just plain bad for them. Not surprisingly, their pain levels remain high and so do their distress levels.

So, what is going on here? The above seems to make no sense. These people are sincere and not malingering or misrepresenting themselves. They cannot simply be dismissed as being crazy. The answer I believe lies with the bond between pain and fear.

Many chronic pain patients report pain performing a particular physical examination maneuver that cannot possibly cause that kind of pain. This kind of examination finding is called a non-organic sign. There is a whole body of research on non-organic signs that has consistently shown these patients to be neither fakers nor simply imagining their pain. Instead these patients have been found to have significant psychological distress. This is in addition to their pain.

Many doctors misinterpret non-organic signs as malingering. This often occurs when examinations are performed to determine eligibility for insurance claims. But those of you who have been following my posts should understand that the experience of pain for these patients is all too real and may be disabling. In #2 of this series, I’ve already explained how the vicious cycle of pain and fear can lead to pain from an activity that should not really be painful.

We tell the patients in our group sessions who get pain with “correct” posture that if they cannot do anything else, they should focus on developing their relaxation skills above all else. They should limit their practice to very short periods and gradually build their tolerance. Pushing such people to work harder will only increase their stress levels and thus increase their pain.

Some are succeeding, but only those who practice.

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