Hi Henry
Hope the private practise work is going well.
Whether psychogenic pain has a satisfactory DSM definition, I am unaware.
However, I do recall there are many sites above the brainstem where pain
can be triggered. In fact, at the cortical level, the orbitofrontal cortex
has been attributed as the highest hierachical neural source of negative
reinforcement. However, neuroanatomists are to this day still mapping
anatomical pathways into this Brodmann's area 13; which goes to show how
unadvanced science is in understanding the higher processing of affective
motivational pain.
It wasn't that long ago that Thalamic Syndrome was considered of Psychic
origin. And how well is RSD (now complex regional pain syndrome type I)
understood today? let alone treated by physios.
As for fibromyalgia and CFS, there is always the interplay and influnece of
the body by and upon the psychoneuroendocrinoimmuno axis. And to reiterate
the power of the immune system upon the CNS, I think we all might have
experienced the delirium and pain accompanying high fever. This represents
just a little of the power of interleukins and interferons upon receptors
in the temporal lobe and hypothalamus.
So when we are faced with apparent psychogenic pain, let's not forget that
the mind and body are a feedback and feedforward continuum not easily
separated by current scientific consensus.
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