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August 2014

Functional PainTime for a New Name

Author Affiliations
  • 1Chronic Pain Program, Pain Treatment Service, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2014;168(8):693-694. doi:10.1001/jamapediatrics.2014.530

The beginning of wisdom is to call things by their right names.

Chinese Proverb

When a comprehensive search to explain a particular symptom or cluster of symptoms does not identify an organic disease, those symptoms are often described as representing a functional disorder. When that symptom is pain, the patient is diagnosed with a functional pain disorder. Although functional gastrointestinal disorders are perhaps the best known members of this family, other entities (fibromyalgia, interstitial cystitis, and chronic daily headaches) are considered functional and encountered by primary care professionals and specialists on a daily basis. In fact, most medical specialties appear to have a functional disorder that commonly occurs within their scope of practice.1 In a survey of general practitioners in the United Kingdom, functional syndromes accounted for 20% of consultations. Yet, despite their frequency, there is general dissatisfaction with the terminology used to describe them and widespread misunderstanding of their etiology, which is often wrongfully assumed to be solely psychological.2,3 This assumption often leads to a reductionistic and often unsuccessful approach to their treatment and frustration for both the physician and the patient.

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