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Pain with surprising causes, or literally no specific cause at all 

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.
Drawing of a knob representing the intensity of back pain, dialed up to 11.

There many paths to pain that never make the headlines.

The question that haunts everyone with unexplained chronic pain: “What if there’s a cause that’s been missed? What if it’s treatable?”

It can happen, and most people are aware of at least a couple ways it can happen. But not many people suspect how many surprising ways to hurt there are.

I’ve recently “completed” a major reboot and expansion of my article, 38 Surprising Causes of Pain: Trying to understand pain when there is no obvious explanation. There’s more to do (always), and suggestions and requests for additions are very welcome (even more than usual), but it’s definitely now a much more comprehensive survey of all non-obvious causes of pain. I hope this will become one of the most useful articles on

The article has always been inspired by the many fascinating stories I’ve heard over the years about people who eventually discovered a specific cause of their pain, like a sneaky drug side effect or a slowly worsening disease, problems with clearly biological origins. However, pain that truly has no particular source is yet another fascinating kind of problem, and likely all-too-real. Here’s an excerpt from the article about that bizarre idea:

Like other complicated things in life, pain may not have any specific cause at all. Although we often speak of pain being multifactorial, we still tend to assume that just one of those factors is the specific cause of pain, and the others — sleep loss, stress, etc — are only piling on, making a bad situation worse. That picture may be wrong: some chronic pain is probably an emergent property of a big mess of synergistic stresses, with literally no specific cause. It may crop up only with an unholy combination of many factors.

This is a “systems” perspective on pain, and it overlaps substantially with sensitization — it’s basically saying that sensitization may be triggered by a bunch of different stresses — but it’s a different enough perspective to be worth considering separately. The idea of pain that truly has no specific cause is something more patients probably need to consider.

Pain with no one cause is a good news scenario in the sense that it might be treated by relieving enough of the contributing factors … but bad news in the sense that it may be like fighting a hydra.

This is line of thinking was directly inspired by a pair of articles by Todd Hargrove:

Do you have a story about pain that was eventually clearly explained? Or never was? Again, I’m more than usually interested in suggestions from both patients and professionals on this topic. I’d love to create the most complete possible list of “surprising ways to hurt,” and I know there’s more than I’ve included so far. Send me an email, or reply to the Tweet or Facebook post.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher