Back pain secondary gain is related to true psychosomatic back pain, but differs in several crucial areas. Secondary gain describes external psychological motivating factors for the initiation or perpetuation of painful symptoms. The patient may or may not be consciously aware of these psychoemotional motivations, but they exist nonetheless.
Secondary gain is a common misdiagnosis for patients with true psychosomatic pain generated from internal emotional issues which have been repressed.
In my own experience working as a trial preparation investigator in New York City, I saw many blatant instances of secondary gain demonstrated by plaintiffs in civil personal injury lawsuits. In some cases, the plaintiff was obviously aware that there was gain to be had from their pain, but in others, the person seemed completely oblivious to the fact that their pain was likely inherently related to their present course of litigation and treatment with a doctor who was a puppet under control of their lawyer.
This essay explores the controversial topic of secondary gain often associated with chronic pain patients.
Primary gain is the actual reason for most psychosomatic pain syndromes to exist. Usually, the primary gain of the symptoms is to cover up unresolved, sensitive and deeply repressed issues within the patient’s subconscious mind. Basically, the pain serves to distract from these repressed emotions, since it is in their nature to strive for conscious recognition.
The subconscious mind fears the release of these repressed emotions and the havoc they may cause in the patient’s consciousness. It is for this reason that the subconscious institutes any of the overwhelming number of psychologically-induced pain syndromes which have become such an epidemic in our healthcare system today.
Secondary gain, unlike primary gain, is symptomatic motivation which affects the patient’s external environment. Rather than protect the patient from internal stressors, secondary gain protects the patient from factors relating to work, interpersonal relationships, finance, responsibilities and any other factors having to do with how the patient interacts with the outside world.
True secondary gain is not consciously caused by the patient in an attempt to benefit from the pain. The patient may or may not realize the benefits of secondary gain, but they do not consciously cause it to be. This is not the same phenomenon as a patient who pretends to be sick or exaggerates a condition on purpose, in order to gain a particular objective. Instead, the recognition of benefit from pain is subconscious and driven without the patient’s conscious control.
Some patients have been told that their pain might have something to do with psychological factors. Unfortunately, most of these patients have been written off by doctors as having a primary physical pain syndrome and a secondary psychological gain perpetuating factor. This is rarely the actual situation for most patients with psychosomatic pain syndromes.
A great number of patients with chronic back pain are actually suffering from psychosomatic primary gain as the one and only source of their physical symptoms. Medical science does not recognize primary gain as the cause of most back ache conditions, which accounts for its dismal treatment statistics.
Accepting the role of the mind in the enactment of physical symptoms is the first and most difficult step for patients to accomplish. However, this realization is vital if they are to be permanently free from their tormenting pain conditions.