Please use the form below to submit comments. Also provide an e-mail address and name. Your e-mail address and/or name will be used only to communicate with you about this or future comments you may submit. I am particularly keen to receive references to published material that contradicts the assertions and arguments I have made.
By submitting the above comment, I grant to Ross Alan Hangartner the right to incorporate the comment in full or in part, literally, paraphrased, or conceptually, as he sees fit, into State of Pain or other writings that he may create in the future. However, I don't grant permission to include my name or e-mail address, or to use them in any other way than to contact me for follow-up. I understand that by submitting the comment I acquire no right of any kind in State of Pain or other writings of Ross Alan Hangartner.
Last updated: Sat, Feb 22, 2025
A "morbidity" is a disease. A co-morbidity is a medical condition or diagnosis that occurs alongside another condition or diagnosis. If you have a sprained ankle along with a headache, both the sprained ankle and the headache have a co-morbidity. When two medical conditions or diagnoses occur together regularly, there is reason to question why. Sometimes the term "co-morbid" can suggest that there may be a common cause for the two conditions, and sometimes it can suggest that one condition in some way causes or facilitates the other.
Dr. David Fishbain, a psychiatric pain researcher, has gone so far as to write that "[t]he hallmark characteristic of a chronic pain patient is co-morbidity."1 He lists all the following as plausible psychiatric co-morbidities of chronic pain:
Quite a list. This is actually a list of putative co-morbidities as they might be understood by a clinical psychiatrist or psychologist, and Fishbain goes on to question the usefulness or sensibility of most of these in the context of chronic pain. (See Psychiatric Co-morbidities of Pain.) This isn't a comprehensive list of all the conditions that have been labeled as co-morbidities of pain. I would add dysautonomia or autonomic dysfunction.
Other authors, writing on peripheral neuropathies, point out the significance of pain's co-morbidities:
"It is common clinical experience that patients with neuropathic pain have significant co-morbid conditions and that these conditions have an important impact on the global pain experience. Psychological factors such as changes in mood, anxiety, and altered sleep patterns have all been identified as significand adjuncts of painful neuropathies, and in addition there may be social isolation and reduced employment status. Approximately 60% of patients report at least discomfort as a result of difficulty sleeping, and moderate to severe depression is present in a third of patients and anxiety in a quarter."2
Lack of sleep is another important co-morbidity of pain. "Lack of sleep certainly does, however, affect the function of the central nervous system. Prolonged wakefulness is often associated with progressive malfunction of the thought processes and sometimes even causes abnormal behavioral activities....We are all familiar with the increased sluggishness of thought that occurs toward the end of a prolonged wakeful period, but in addition, a person can become irritable or even psychotic after forced wakefulness."3
The fact that these conditions are "co-morbid" reflects the fact that these conditions are treated in different medical specialties. The effects you experience from these co-morbid conditions, however, aren't separate and distinct from your experience of just-the-pain. My understanding of the neuroscience of pain tells me that these co-morbid symptoms are part and parcel of the pain, and in many ways may be the most important aspects of pain. I share this understanding with you in A Rational Model of Emotion and Pain and The Challenge of Living in Pain.
I believe that this new understanding should have important implications for medical treatment of pain sufferers.