Opinion Can the pain field learn from the functional somatic disorder field? 2025 Gormsen, Fink et al

[Andy]

"A 41 year old woman presents at a pain clinic. She developed symptoms 10 years ago, starting with lower back pain, tiredness, chest pain, and palpitations. The pain spread to her joints and muscles with numbness and weakness, and she developed gastrointestinal problems, tinnitus, visual disturbances, and trouble sleeping. Over the past year, severe fatigue developed, causing missed work and weekends spent resting. Her symptoms worsen with stress." If this patient was seen at a pain clinic, the focus would likely be on pain symptoms. However, if she was seen by a cardiologist, the focus would be on heart symptoms, receiving the diagnosis of atypical chest pain, and at the gastroenterologist, she would be diagnosed with irritable bowel syndrome. It is increasingly acknowledged that many chronic pain patients have other distressing symptoms than pain, 4.8,29,35,45,47 While differences exist, 20.46 there is also a significant overlap in the symptoms, predictors, mechanisms, prognosis, and treatment of the patients' various complaints, 4,11,24,28,35

In this perspective, we argue that when patients experience multiple symptoms in addition to pain, a broader view will strengthen the treatment in the pain clinics as well as research into the underlying mechanisms.

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[Liie]

It annoys me so that they don't seem to dare to call things "psychosomatic" or "psychogenic" when that is what they mean. It seems disingenuous and manipulative.

It can't be only us in the ME/CFS community that think so? It must be other patients, clinicians and researchers also?

There probably is some -- maybe a lot -- psychosomatic illness out there that could benefit from some kind of psychotherapy-based treatment. No wrong in that. But they should just use that term if that is what they mean.

 

[rvallee]

If this patient was seen at a pain clinic, the focus would likely be on pain symptoms. However, if she was seen by a cardiologist, the focus would be on heart symptoms, receiving the diagnosis of atypical chest pain, and at the gastroenterologist, she would be diagnosed with irritable bowel syndrome

It's really hard to believe this isn't trolling. I believe it, it's just really hard. It's so ridiculous, it's like the profession never developed basic skills. And yet they did, obviously, but again and again you have these completely absurd takes like this that reflect zero understanding of the lived reality of sick people or how we experience health care.

You call a mechanic and somehow they don't know what to do about your plumbing problems and they keep focusing on mechanical things what's up with that? asks the fool.

Everything has to be "just right". No in any coherent way, but their way, the way they expect it to, even if it makes no sense. You talk about more symptoms, and they complain that you have too many symptoms. You focus on the knowledge area of a specialist, and somehow that's weird and fixating. Also if you have too many symptoms and aren't geriatric then it's impossible, plus you just want a diagnosis, somehow, because it's imagined that it's "cool" and "mystical", which is completely ridiculous. Also consults have to be about one symptom and one symptom only. But also why didn't you bring this up until now? Which would have been dismissed, in fact probably has, many times. This is capricious impotence. So many excuses. They are the excuses people.

 

[rvallee]

Also the idea of the chronic pain field learning from the psychosomatic ideologues is basically like saying that the person who finished last should teach the person who finished second-to-last about how to win, just completely laughable. The truth is that neither of those disciplines have anything to teach anyone, they haven't even started the learning process, literally have zero achievements to show for it.

But they keep awarding themselves trophies and so they point at their fake trophies as proof of their many achievements. Who needs real trophies when you can just order them in bulk for yourself?

 

[Sean]

Can the pain field learn anything from the functional somatic disorder field?

Sure they can. But that is the wrong question.

The right question is what will they learn, and will it benefit patients?

To which the indisputable answer is: how to get it even more wrong, and no.

 

[Andy]

There probably is some -- maybe a lot -- psychosomatic illness out there that could benefit from some kind of psychotherapy-based treatment. No wrong in that. But they should just use that term if that is what they mean.

I can't agree with this. In my opinion the idea of psychosomatic illnesses is like a child believing in Father Christmas delivering presents for them; an observed phenomenon has the incorrect causation attributed to it.