Treat the Patient, Not the Label: A Pain Neuroscience Update

Abstract

When dealing with chronic pain, it is often not possible for clinicians to provide adequate answers to their patients about what might be wrong, and why they continue to have their pain. This has led to greater use of diagnostic “labels” for conditions such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic Lyme disease, and many others. Assigning such “labels” to patients with chronic pain has far-reaching consequences for all stakeholders. The aim of this clinical commentary is to highlight some of the common threads among 4 particular conditions common to women—fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and chronic Lyme disease—when it comes to the underlying neurobiology and its consequences for the patient and treating clinicians. By taking a “big picture” view of pain as a multiple system output activated in response to threat, we discuss how the various output systems activated can lead to clusters of symptoms that may predispose patients to one or other of these 4 diagnostic conditions. There is now emerging evidence that during the biological response to threat, one output system may be more affected than the others and dominate the clinical picture, hence manifesting as a particular diagnostic condition. We propose that ultimately, these conditions essentially mean the same thing, that the patient has chronic pain, and we advocate for treatment of the patient, not the condition. The ability to look beyond the “label” and seeing the person in front of you is imperative when it comes to providing hope.