The Disease

Psychogenic pain (AKA, psychalgia) is pain that is caused, aggravated, or prolonged by emotional, mental, or behavioral factors.  Headache, stomach ache, heart ache, and other emotion-related pains are one type of psychogenic pain.  However, any pain from any cause can have a component of psychogenic pain, as pain often produces emotions that can magnify one’s perception of the pain.

Pain is not a disease but a perception to a real or perceived noxious stimulus.  The final determinate to whether something is painful or not is made in the brain.  In nociceptive pain, receptors on our peripheral nerves are stimulated (i.e., we cut our finger), they transfer this information through our peripheral nerves to the spinal cord, the spinal cord transfers this information up to our brain stem, the information is then distributed to many different parts of the brain who “report their analysis of this information” to the pain center in our brain which then “decides whether or not our finger hurts”.  As you can see, the final determination of “hurt or not hurt” is made in the brain.  In psychogenic pain, the brain decides that something hurts, not because that part of our body is sending messages to the brain but because our emotions, mental state, or behavior has made the brain “decide” to make us feel pain in that area.

Although it may magnify idiopathic pain (pain where the cause is unknown), psychogenic pain is different in that the cause is usually unown, i.e., stomach ache in emotionally upset children, heart ache after the loss of a loved one, etc.  Psychogenic pain is different from neuropathic pain (pain caused by damage to the nerves) and from allodynia (pain felt due to the stimulation of non-painful peripheral nerves) in that in psychogenic pain the nerves are normal and the stimulation of the pain originates in the brain rather than in the periphery.  We “feel” the pain in the periphery (in our stomach, chest, abdomen, etc.) but the pain is not originating there.  For many cases, psychogenic pain doesn’t last for relatively short time and resolves when the emotional stimulus has been removed.  However, for some the stimulus causing the pain is not readily removable or is continuously or frequently remembered and they may suffer from psychogenic pain for a long time.  This constant stimulus of pain can become ingrained in their brain and cause them to continue to have pain, even after the stimulus that originally caused the pain has been removed.

The Research

Little to no direct research has been reported using cannabinoids to treat psychogenic pain, however, lots of research has been done examining the effect of cannabinoids on the perception of pain and the “remembering” of experiences associated with emotional pain (i.e., PTSD, etc.).  A portion of our brain’s frontal lobe called the Anterior Cingulate Cortex (ACC) link the feeling of pain with the emotional experience of the pain.1,2  In both animals and humans, the nerves in the ACC help us to identify situations that cause pain and to avoid those situations and damage to the ACC can prevent one from learning that a particular stimulus produces pain.3-6  Therefore, psychogenic pain may be caused by emotions stimulating the ACC and subsequently causing us to “feel” pain somewhere in our body.  It is known that injecting CBD into the ACC in rats that were experiencing nociceptive pain caused the rats not to exhibit any fear of the stimulus causing the pain.6  Neuroimaging studies in humans have found evidence for a critical modulatory role of the ACC in the effects of CBD.7  Therefore, it appears that CBD tends to disassociate emotions from pain through its actions on the ACC.  This ability of CBD to disassociate emotions from memory recall via the ACC has been shown to be extremely beneficial in PTSD patients (see Diseases/Post Traumatic Stress Disorder in this website for more details) and it may be that similar disassociation may be helpful in persistent psychogenic pain.

In addition, many other hard to treat pain conditions that previously had unknown causes have been proposed to involve a deficiency of the endocannabinoid system.8 Treatment with CBD has been proposed as an alternative for these hard to treat pain conditions some of which were previously were thought to be psychogenic in nature.  A recent example of this is the pain caused by VGKC-complex autoimmunity. In this disease, the patient makes antibodies against their own nerves and these antibodies attach to voltage-gated potassium channels (VGKC).  When this happens, the nerve becomes hyperexcitable and starts sending “pain” signals to the brain.9 CBD inhibits VGKC-activation in neurons which would decrease the pain in these conditions.10   In psychogenic pain, it is thought that the neurons somewhere along the “pain pathway” from the sensory receptors in the periphery to the “pain deciding centers” in the brain have become hyperactive and are making the person feel pain.  If this is so, CBD may be able to eliminate this pain.

Bottom Line

Little to no direct research of the effect of CBD on psychogenic pain.  There is theoretical evidence that suggests it may be helpful for psychogenic pain by both its effects on separating emotional responses from memory and actions and by its inhibiting the pain associated with neuronal hyperexcitability.  At this time, the FDA has not approved CBD for the treatment of psychogenic pain.

 

References

  1. Lane RD, etal. Neural correlates of levels of emotional awareness. Evidence of an interaction between emotion and attention in the anterior cingulate cortex. J Cogn Neurosci 1998;10(4):525–35.
  2. Davis, KD., etal. “Functional MRI of pain- and attention-related activations in the human cingulate cortex”,  Neurophysiol.1997;77:3370–80.
  3. Qu C, etal. Lesion of the Rostral Anterior Cingulate Cortex Eliminates the Aversiveness of Spontaneous Neuropathic Pain FollowingPartial or Complete Axotomy. Pain 2001;152(7): 1641–1648.
  4. Hutchinson WD, etal. Pain-related neurons in the human cingulate cortex.  Nat Neurosci 1998;2:403-5.
  5. Koyama T, etal. Anterior cingulate activity during pain-avoidance and reward tasks in monkeys. Neurosci Res. 2001 Apr;39(4):421-30.
  6. Genaro K, etal. Cannabidiol is a potential therapeutic for the affective-motivational dimension of incision pain in prats.  Front Pharmacol 2017;8:391
  7. Fusar-Poli P, etal. Distinct effects of {delta}9-tetrahydrocannabinol and cannabidiolon neural activation during emotional processing.  Arch Gen Psychiatry. 2009 Jan;66(1):95-105.
  8. Russo EB. Clinical endocannabinoid deficiency (CECD): can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuro Endocrinol Lett. 2008;29(2):192-200.
  9. Klein CJ, etal. Chronic pain as a manifestation of potassium channel-complex autoimmunity.  Neurology 2012 Sep 11;79(11):1136-44.
  10. Ghovanloo MR, etal. Inhibitory effects of cannabidiol on voltage-dependent sodium currents. J Biol Chem. 2018 Sep 14. pii: jbc.RA118.004929.

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