Can the pain field learn from the functional somatic disorder field?

“A 41-year-old woman presents at a pain clinic. She developed symptoms 10 years ago, starting with lower back pain, tiredness, chest pain, and palpitations. The pain spread to her joints and muscles with numbness and weakness, and she developed gastrointestinal problems, tinnitus, visual disturbances, and trouble sleeping. Over the past year, severe fatigue developed, causing missed work and weekends spent resting. Her symptoms worsen with stress.” If this patient was seen at a pain clinic, the focus would likely be on pain symptoms. However, if she was seen by a cardiologist, the focus would be on heart symptoms, receiving the diagnosis of atypical chest pain, and at the gastroenterologist, she would be diagnosed with irritable bowel syndrome. It is increasingly acknowledged that many chronic pain patients have other distressing symptoms than pain.4,8,29,35,45,47 While differences exist,20,46 there is also a significant overlap in the symptoms, predictors, mechanisms, prognosis, and treatment of the patients' various complaints.4,11,24,28,35

In this perspective, we argue that when patients experience multiple symptoms in addition to pain, a broader view will strengthen the treatment in the pain clinics as well as research into the underlying mechanisms.