This is unfortunately a commonly cited dismissal of patients by health care professionals and usually indicates that the health professional can not see any obvious reason for pain and dismisses it as being the fault of the patient in pain. It may be said as much in exasperation as anything at his/her inability to make sense of what their patient is telling them. It is certainly true that we need a brain to feel pain and the effects of the brain/mind on our state of pain can be very profound in ways we do not fully understand or appreciate.
Imaginary or psychogenic pain is very rare. The likelihood is that all pain has a physical cause; unfortunately sometimes it is difficult to have any if not all the answers as to why an individual may experience pain. Obviously there is a huge benefit in dealing with a healthcare professional that has specialised training in dealing with chronic pain conditions. To this end patients will often state that “this may sound a little strange” when relating an experience that they may have had due to their pain condition. My response is that it is highly unlikely that you will tell me something I have not heard previously from a patient. In other words strange as it may seem to the patient, their experience will be similar to what many others have experienced.
Pain is a fundamental part of our existence and some refer to it as our sixth sense. It is essential to protect us from injury. However some forms of pain have no function and as such may represent a malfunction of the pain system. Thus the initial cause of the pain may have long since resolved, but pain continues with no physical sign to go with the pain. The person with a hole in the tooth can understand why they have pain and can relate to friends and family on this basis as all will appreciate that a problem tooth equates to pain. However the apparent cause of the pain has been dealt and pain continues explaining the pain to oneself or others becomes more difficult. Either this represents a pain system malfunction (neuropathic pain), which is highly unusual in the area of the mouth, or an incorrect diagnosis for the original cause of the pain. The end result is pain with no apparent cause both to the examining doctor and the patient, with resulting frustration for both.
This type of pain is referred to as chronic pain and typically represents pain which has been present for more than six months, itself an arbitrary time frame in which we would expect injury to heal and pain to resolve. Many forms of chronic pain do not respond to conventional pain killers leading to bewilderment on the part of the patient and scepticism on behalf of friends and family who are disbelieving that the sufferer has a pain that does not go away. In this situation both begin to wonder is the pain imaginary. The answer being more than likely it is not imaginary.
The relationship between chronic pain and mood disorders is a very complex issue and works in both directions. So we find that those who are depressed have a much higher level of pain than the non-depressed. The obvious inference would seem to be that the depressed patient imagines the pain, again highly unusual. Pain may cause depression, which is understandable as a diagnosis of a chronic pain condition that is unlikely to be treatable is very definitely a reason for concern if not outright depression or anxiety. The same applies to pain which has not been correctly diagnosed and it is left to the patient to wonder if the pain is cause by some undiagnosed horror situation such as for example a brain tumor. Brain tumors can obviously cause pain, but are in themselves a relatively uncommon occurrence.
In summary correct diagnosis and in some cases recognition that the patient has a pain with in some rare instances no effective treatment is better than uncertainty and doubt which accompanies the suggestion that “it is all in the mind”.