Psychogenic diseases — all in your head?

I have a friend who suffers from chronic pain.  She has tried meditation, acupuncture, opioids, yoga and all manner of other remedies.  Chances are, if anyone, anywhere, has said something will help with the pain, she has tried it. She has visited an untold number of doctors.  Each has examined her thoroughly and put her through a variety of invasive tests.  Despite their most careful administrations, none have found the root of her pain.  And most have sent her on her way with a glib, “We can find nothing wrong with you.  The pain is all in your head.”

While these doctors might have meant to be dismissive, there might have been more truth in their “all in your head” comments than they realized.  A new study from the University of Cambridge and University College London suggests that those that suffer from psychogenic disease (often called “hysterical” disease) have brains that function differently.  The results were published last month in the journal Brain. 

The researchers compared individuals with dystonia, painful and disabling muscle contractions in the leg.  Half of the individuals studied had organic dystonia, cased by a gene mutation.  The other half had the psychogenic variety of the disease–meaning they showed the same symptoms as those with organic dystonia but no physical explanation behind those symptoms. 

When the researchers used positron emission tomography (PET) to examine the brains of all study participants while they rested their foot, moved their foot and then held their foot in a dystonic position.  They found that study participants with psychogenic illness showed very different brain activity than those with the organic variety of the disease–no matter what position the foot happened to be in.  What’s more, the researchers did not find significant activity in prefrontal cortex, thought to be the brain region behind psychogenic pain.  All dystonic patients showed activity in this area when they tried to move their foot, too.

Often, people like my friend are made to feel like they are crazy, that they are imagining their problems or perhaps even faking their pain in order to gain attention.  But this research suggests that there may be more to the story–and studies like these may inform future diagnostic tests and treatment. 

Of course, these different patterns of brain activity could actually mean all manner of different things:  a different sort of organic cause for pain, some kind of stress, even perhaps imagined sensations.  It’s unclear at this point.  Still, this is an intriguing finding.  What do you think?  Could psychogenic illness be explained by a difference in the way the brain processes signals?

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