Functional Pain: Preface

By | November 16, 2011

There is always the underlying assumption that if only we could build a better microscope we would be able to see the structural abnormality.

This is an odd name for a series of blogs, since most of the pain that I treat is dysfunctional. That is after all why they come to see me. The pain has gotten to the point that it is interfering with their lives and they want me to do something about it.

I am using the term in its pathophysiologic sense and in contradistinction to structural pain. Over the past 200 years great strides have been made in medicine, often led by pathologists who examine bodies, parts or tissues and try to correlate disease states with alterations in structure. One of the underlying postulates of modern medicine and physiology is that function follows structure and indeed for most organ systems this is fairly accurate.

My contention is that when it comes to the nervous system, this is only partially true. There are many diseases and chronic pain conditions where there is no visible alteration in gross or microscopic anatomy. These conditions have been termed functional disorders, because there appears to be an alteration in function without a corresponding alteration in structure. These conditions are for the most part less well understood and there is always the underlying assumption that if only we could build a better microscope or ultrasound machine we would be able to see the structural abnormality.

After 25 years of practice I now firmly believe that at least for the central nervous system this is not true. In the following blogs I will develop this theme more fully and even argue that with the inherent plasticity of the human body, our basic assumptions about form and function may be in error. Perhaps it would be more productive to say that abnormal form results from abnormal function. In any case in the next several blogs I will ask you to follow the advice of Apple founder Steve Jobs and “Think Different”.


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