Encoding States: A Model for the Origin and Treatment of Complex Psychogenic Pain

Pain that is “unanatomical” in distribution, for which there is no recent history of trauma, no evidence of a peripheral lesion and that resists traditional treatment, should be considered to be of psychogenic origin. The term complex psychogenic pain can be used when autonomic changes such as temperature abnormalities and physical findings such as tenderness accompany the pain. It is proposed that complex psychogenic pain is co-encoded centrally during a traumatizing event where the person experiences rage or fear with concomitant pain but is constrained from responding to the circumstances. Complex psychogenic pain is encoded as dissociated from the event. However, subsequent subconscious stimuli that recreate similar emotional, somatosensory, or cognitive states can activate a re-perception of the traumatic pain and engage various vasomotor processes. It is speculated that complex psychogenic pain is generated from amygdala efferents and is encoded in such a manner that precludes simple forgetting. Therapy consists of either delinkng the amygdala-based connection between the memory of the event and the emotional/somatosensory response or directly inhibiting amygdala outflow. Successful therapy extinguishes the pain.