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Vol. 46 No. 1 (2026)
Revista Portuguesa de Psicanálise

Pesquisa

The Enigma of Chronic Pain in the Light of a Classic by G. Engel: 'Psychogenic Pain and the Pain-prone Patient'

https://doi.org/10.51356/rpp.461a9

Published 2026-07-22

  • João Paulo Consentino Solano

João Paulo Consentino Solano
Centro Universitário São Camilo

Abstract

Chronic non-cancer pain represents a challenge to curative medicine, with therapeutic success rates below expectations despite the advances of neuroscience, psychopharmacology, and invasive approach techniques. This paper presents an analysis of a classic 1959 article by George Engel – Psychogenic pain and the pain-prone patient. For that author, the experience of pain is understood as a psychic phenomenon in its engendering and, particularly, in the processes of recurrence and chronification. This means that, in chronic pain, the existence of inflamed or injured peripheral tissues is dispensable (and fruitless its search by medical sciences efforts). That author describes the clinical characteristics of a significant ammount of patients – whom he calls pain-prone patients – for whom any treatment needs to reach the psychic instance where the pain is inscribed, instead of targeting peripheral physical/bodily structures. The contents addressed by the author, psychiatrist and psychoanalyst, become current again and shed light on the delineation of a third mechanism underlying chronic pain cases, recently named 'nociplastic pain', and the current categorization of chronic pain as a primary disease by the 11th. version of the International Classification of Diseases.

Keywords

chronic pain, nociplastic pain, psychogenic pain, primary chronic pain, non-oncologic chronic pain

PDF (Português)

Author Biography

João Paulo Consentino Solano

Médico psiquiatra. Psicanalista na Clínica Dr. Roberto Azevedo. Professor Titular nas disciplinas de Psiquiatria e Dor do curso de Medicina do Centro Universitário São Camilo, São Paulo, Brasil. Autor de Cartas de Telêmaco: do ciúme à inveja, do amor à paixão (Ed. Scortecci, 2012).

References

  1. Adams, G.R., Gandhi, W., Harrison, R., van Reekum, C.M., Gilron, I. & Salomons, T.V. (2021). Do “central sensitization” questionnaires reflect measures of nociceptive sensitization or psychological constructs? Protocol
  2. for a systematic review. Pain Reports 6(4), e962. https://doi.org/10.1097/PR9.0000000000000962.
  3. Arendt-Nielsen, L., Brennum, J., Sindrup, S. & Bak, P. (1994). Electrophysiological and psychophysical quantification of temporal summation in the human nociceptive system. European Journal of Applied Physiolo and Occupational Physiolo, 68, 266-273.
  4. Borrell-Carrió, F., Suchman, A.L. & Epstein, R.M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med., 2(6), 576-582. https://doi.org/10.1370/afm.245.
  5. Cohen, J. (2000). George L. Engel, MD. JAMA, 283(21), 2857. https://doi.org/10.1001/jama.283.21.2857
  6. Cohen, S. P., Fitzcharles, M. A., & Hauser, W. (2022). Nociplastic pain is functional pain : Authors’ reply. Lancet, 399(10335), 1604. https://doi.org/10.1016/S0140-6736(21)02506-X
  7. Covington, E. C. (2000). President’s message. Pain Medicine, 1(2), 107-109.
  8. Dowling, A. S. (2005). George Engel, M.D. (1913–1999). American Journal of Psychiatry, 162(11), 2039-2039. https://doi.org/10.1176/appi.ajp.162.11.2039
  9. Engel, G.L. (1977). The need for a new medical model: A challenge for Biomedicine. Science 196,129-136. https://doi.org/10.1126/science.847460
  10. Engel, G.L. (1959). Psychogenic pain and pain-prone patient. The American Journal of Medicine, 26(6), 899-918. https://doi.org/10.1016/0002-9343(59)90212-8.
  11. Fields, H.L. (2018). How expectations influence pain. Pain., 159, S3-S10. https://pubmed.ncbi.nlm.nih.gov/30113941/
  12. Fitzcharles, M. A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: Towards an understanding of prevalent pain conditions. Lancet, 397(10289), 2098-2110. https://doi.org/10.1016/S0140-6736(21)00392-5
  13. Friedman, R. (1975). Some characteristics of families of children with “psychogenic pain”. Journal of Clinical Child Psycholo, 4(3), 21. https://doi.org/10.1080/15374417509532663
  14. Hausteiner-Wiehle, C., & Henningsen, P. (2022). Nociplastic pain is functional pain. Lancet, 399(10335), 1603-1604. https://doi.org/10.1016/S0140-6736(21)02500-9
  15. Isagulyan, E. D., Makashova, E. S., Myasnikova, L. K., Sergeenko, E. V., Aslakhanova, K. S., Tomskiy, A. A., Voloshin, A. G., & Kashcheev, A. A.(2022). Psychogenic (nociplastic) pain: Current state of diagnosis, treatment options, and potentials of neurosurgical management. Progress in brain research, 272(1), 105-123. https://doi.org/10.1016/bs.pbr.2022.03.008
  16. Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. The New England Journal of Medicine, 331(2), 69-73. https://doi.org/10.1056/NEJM199407143310201.
  17. Jo, D. (2024). A comprehensive overview and scope of interventional pain management. The Korean Journal of Pain, 37(2), 89-90.
  18. Kosek, E., Clauw, D., Nijs, J., Baron, R., Gilron, I., Harris, R. E., Mico, J. A., Rice, A. S. C., & Sterling, M. (2021). Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain, 162(11), 2629-2634. https://doi.org/10.1097/j.pain.0000000000002324
  19. Kwan, O., Ferrari, R., & Friel, J. (2001). Tertiary gain and disability syndromes. Medical Hypotheses., 57(4), 459-464. https://pubmed.ncbi.nlm.nih.gov/11601869/
  20. Lo Bianco, G., Tinnirello, A., Papa, A., Marchesini, M., Day, M., Palumbo, G. J., Terranova, G., Di Dato, M. T., Thomson, S. J., & Schatman, M. E. (2023). Interventional pain procedures: A narrative review focusing on safety and complications. PART 2 Interventional procedures for back pain. Journal of pain research, 16, 761-772. https://doi.org/10.2147/JPR.S396215
  21. Lugg, W. (2022). The biopsychosocial model: History, controversy and Engel. Australasian psychiatry: bulletin of Royal Australian and New Zealand College of Psychiatrists, 30(1), 55-59. https://doi.org/10.1177/10398562211037333
  22. Nakamura, M., Nishiwaki, Y., Sumitani, M., Ushida, T., Yamashita, T., Konno, S., Taguchi, T., & Toyama, Y. (2014). Investigation of chronic musculoskeletal pain (third report): With special reference to the importance of neuropathic pain and psychogenic pain. Journal of orthopaedic science: official journal of the Japanese Orthopaedic Association, 19(4), 667-675. https://doi.org/10.1007/s00776-014-0567-6
  23. Nijs, J., Lahousse, A., Kapreli, E., Bilika, P., Saraço?lu, ?., Malfliet, A., Coppieters, I., De Baets, L., Leysen, L., Roose, E., Clark, J., Voogt, L., & Huysmans, E. (2021). Nociplastic Pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. Journal of clinical medicine, 10(15), 3203. https://doi.org/10.3390/jcm10153203
  24. Pawl, R. (2013). “When the pain won’t wane it’s mainly in the brain”. Surgical Neurolo International, 4(5), S330-333. https://pmc.ncbi.nlm.nih.gov/articles/PMC3717530/
  25. Solano, J. P. C. (2014). Fracasso crônico no tratamento da dor crônica? A influência silenciosa da personalidade e seus transtornos. Acta Fisiatrica, 21(2), 93-100. https://doi.org/10.5935/0104-7795.20140020
  26. Solano, J. P. C. (2023). Phármakon equivocado para diagnósticos imprecisos: O exemplo da depressão em pacientes com dor crônica. Revista Brasileira de Psicanálise, 57(4), 97-113. https://doi.org/10.69904/0486-641x.v57n4.08
  27. Stamp, G.E., Wadley, A.L., & Iacovides, S. (2024). Could relationship-based learnt beliefs and expectations contribute to physiological vulnerability of chronic pain? Making a case to consider attachment in pain research.
  28. The Journal of Pain, 25(11), 104619. https://www.jpain.org/article/S1526-5900(24)00560-1/fulltext
  29. Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz,
  30. J., Schug, S., Smith, B. H., Svensson, P., … Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003-1007. https://doi.org/10.1097/j.pain.0000000000000160
  31. University of Rochester Medical Center. The papers of George L. Engel. Edward G. Miner Library, Archives and Manuscripts [dezembro 30, 2024]. https:// urmc.rochester.edu/libraries/miner/rare-books-and-manuscripts/archives-and-manuscripts/faculty-collections/the-papers-of-george-allen-papers-engel
  32. Von Hagen, K. O. (1957). Chronic intolerable pain; discussion of its mechanism and report of eight cases treated with electroshock. Journal of the American Medical Association, 165(7), 773-777.
  33. Weisberg, M.B., & Clavel, A.L. (1999). Why is chronic pain so difficult to treat? Psychological considerations from simple to complex care. Postgraduate Medicine, 106(6), 141-142, 145-148, 157-160. https://doi.org/10.3810/pgm.1999.11.771
  34. Roo, Y-M., & Kim, K.H. (2024). Current understanding of nociplastic pain.
  35. Korean J Pain, 37(2), 107-118. https://doi.org/10.3344/kjp.23326