Q&A: How a self-assessment can help physicians identify symptoms caused by stress, trauma

Key takeaways:

• Medically unexplained illness or pain caused by stress and trauma is common in the U.S. but difficult to diagnose.
• A short self-assessment could help physicians pin down the cause of a patient’s symptoms.

Primary care providers can use self-assessments and other resources to diagnose medically unexplained chronic symptoms and offer relief for patients, according to an expert.

Pain and illness that is medically unexplained can sometimes be caused by stress or trauma, according to David D. Clarke, MD, president of the nonprofit Psychophysiologic Disorders Association. But it can be tough for PCPs to recognize when psychophysiologic disorders or neuroplastic symptoms are fully responsible for a patient’s complaints.

In response, Clarke helped create a 12-question self-assessment that can help determine if the cause of their illness or pain is psychophysiologic in nature.

Healio spoke with Clarke to learn more about medically unexplained chronic pain, the assessment he created and more.

Healio: How prevalent is medically unexplained chronic pain? Is this something PCPs encounter regularly?

Clarke: Forty percent of primary care patients have medically unexplained pain or illness and so does 20% of the general adult population. Common forms include migraine, fibromyalgia, irritable bowel, interstitial cystitis, spine pain (lumbar or cervical), pelvic pain, genital symptoms, long COVID, chronic fatigue, functional neurologic disorders, certain rashes and many more. We call these conditions neuroplastic symptoms or psychophysiologic disorders.

Healio: How difficult is it to diagnose stress-induced chronic pain?

Clarke: It can be very easy in some patients if you ask the right questions. For example, a patient whose pain occurred only while driving to work or a teenager who had diarrhea only on Tuesdays and Thursdays. Diagnosis also can be as challenging as anything in medicine. An example is a teenager in the hospital for 70 days on morphine around the clock for abdominal pain undiagnosed after six gastroenterology consultations.

Healio: Will you describe this self-assessment? Why did you create it?

Clarke: Psychophysiologic — or neuroplastic — symptoms often have certain characteristics and occur in patients who have their own particular characteristics. By asking about these in a 12-item self-assessment quiz that takes less than 3 minutes, we can give people a reasonable idea about whether a neuroplastic/psychophysiologic process might explain their pain or illness.

Healio: Can PCPs use this assessment in their practices? How would it benefit them to do so?

Clarke: Yes. The self-assessment quiz includes brief information to explain each question so that, by the end, patients whose illness has characteristics of a psychophysiologic disorder will be interested to know how to further pursue diagnosis and treatment. It is available on EndChronicPain.org.

Healio: If the PCP discovers that a patient’s chronic pain is the product of stress, how should they proceed with treatment?

Clarke: There are courses on the website, recorded conferences and textbooks that explain how to conduct a full stress evaluation to uncover all the issues contributing to the patient’s condition. These include current life stresses; somatic presentations of depression, anxiety or PTSD; and the long-term impact of adverse childhood experiences. These can then be managed by a behavioral or mental health clinician who has learned from these resources and is therefore comfortable evaluating and treating the particular types of psychosocial issues that cause physical pain or illness.

Healio: What is the take-home message for PCPs here?

Clarke: The brain can generate pain or illness anywhere in the body in the absence of organ disease or structural damage. These symptoms can be just as severe as those caused by any other illness. If you know what to look for, this form of illness can be diagnosed and treated at least as successfully as diseased organs or damaged structures.

Healio: Is there anything else you would like to add?

Clarke: A family physician who completed our online courses took me aside at a conference last year and said, “These ideas have put the joy back into my work.”

Reference:

• Psychophysiologic Disorders Association. Self-assessment quiz. Available at: https://ppdassociation.org/ppd-self-questionnaire. Accessed Oct. 9, 2024.