Generalized psychogenic or idiopathic pain

Specialty: General.

• diffuse somatoform pain
• persistent idiopathic body pain
• chronic generalized pain disorder

Why it occurs

• Somatization disorder or chronic somatic symptom disorder (where unresolved emotional conflicts or post-traumatic stress are expressed through somatosensory pathways)
• Central sensitization of the central nervous system (alteration of nociceptive processing in the dorsal horn of the spinal cord with loss of descending pain inhibitory pathways)
• Major depressive disorder with prominent physical symptoms (associated with functional deficit of serotonin and norepinephrine in the analgesic pathways of the nervous system)
• Chronic post-traumatic stress disorder (hyperactivity of the hypothalamic-pituitary-adrenal axis that sensitizes peripheral receptors to pain)
• Complex regional pain syndrome in the phase of infrequent generalization.

Initial workup

Careful ruling out rheumatological pathologies using antinuclear antibodies (ANA), rheumatoid factor, anti-cyclic citrullinated peptide antibodies (anti-CCP), ESR and CRP levels, electromyography of extremities, and psychiatric and clinical psychology evaluation.

Standard management

• Duloxetine — 30 to 60 mg orally once daily in the morning, a dual serotonin and norepinephrine reuptake inhibitor that modulates descending analgesic pathways
• Amitriptyline — 10 to 25 mg orally at night, excellent pain modulator at low doses
• Pregabalin (75 to 150 mg orally divided into two doses per day to stabilize neuronal membranes by binding to the alpha-2-delta subunit of calcium channels).