Last updated: Mon, Jul 3, 2017
The search for a "pain-prone personality" and for "psychogenic pain" has proven to be futile.1
Nevertheless, it is discussed in entire seriousness on p. 408 and again on p. 437 by two separate contributors to the volume in which the above quote appears.
Convincing evidence that chronic pain is usually the cause rather than the result of neurotic symptoms derives from studies of patients who are eventually relieved of their pain. Typically, these patients, while they are suffering chronic pain, show evidence of psychological disturbance on the Minnesota Multiphasic Personality Inventory (MMPI). In particular, they have elevated scores on the scales for hysteria, depression and hypochondriasis. Some investigators have argued that these personality characteristics lead to chronic pain after minor injuries. However, the evidence points in the other direction: that pain produces the elevations in these emotional characteristics. Significant decreases in several key MMPI scales (hysteria, depression, hypochondriasis and anxiety) occur after successful treatment of chronic pain with a variety of therapies. Similarly, patients suffering several forms of chronic pain--including headache, colitis and abdominal pain--were found to have lower self-esteem than pain-free control groups. However, after these patients underwent several therapeutic procedures that significantly reduced their pain, they showed a striking improvement in their self-esteem ratings.
It is evident from studies such as these that it is unreasonable to ascribe chronic pain to neurotic symptoms. The patients with the thick hospital charts are all too often prey to the physician's innuendoes that they are neurotic and that their neuroses are the cause of the pain. While psychological processes contribute to pain, they are only part of the activity in a complex nervous system. All too often, the diagnosis of neurosis as the cause of pain hides our ignorance of many aspects of pain mechanisms.2