Reply to letter to the editor by Toda

Excerpt

Pain has various dimensions, and there are classification concepts of pain according to its course (acute pain, chronic pain), its site of occurrence (somatic pain, visceral pain, referred pain), and its cause [nociceptive pain, neuropathic pain, psychogenic pain (= somatic symptom disorder)]. Pain is a very subjective sensation, and in order to deal with it scientifically the international association for the study of pain has defined pain as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Because, as stated in this definition, pain is an unpleasant sensory experience, and it is an unpleasant emotional experience, a psychological factor always appears to be present. On the other hand, Wall & Melzack’s Textbook of Pain says in regard to psychogenic pain that it is a: “Report of pain attributable primarily to psychological factors usually in the absence of any objective physical pathology that could account for pain.” Thus, logically, the diagnostic criterion for psychogenic pain is exclusion of organic disease, and when one considers that even a change as slight as someone’s hair being pulled leads to pain, in reality it appears almost impossible to completely exclude organic factors. However, because of the powerful impact of psychological factors, a strong unpleasant experience may occur even when the organic pathology would not be expected to cause pain and, logically, we think that its presence is a symptom of a mental disorder (anxiety neurosis, depression, abnormal cognitive function, etc.). …