It’s a question often left unsaid in the consultation room, but heavily implied: “Is this pain even real?”
Functional pain — pain without identifiable tissue damage or structural pathology — continues to challenge clinicians and frustrate patients. It sits in that uncomfortable space between physical and psychological, where test results offer no answers, yet the patient’s suffering is very real.
If not handled carefully, conversations about functional pain can erode trust, trigger shame, and lead to disengagement from care. But when framed with compassion and clarity, these conversations can become a turning point — helping patients understand their pain and move forward with evidence-based support.
What Is Functional Pain?
Functional pain is pain that arises from disrupted pain processing, not from ongoing damage or disease. It’s real, felt in the body, and often chronic. It may overlap with central sensitisation, dysregulation of the autonomic nervous system, or post-viral syndromes (e.g., Long COVID). Common examples include:
- Fibromyalgia
- Functional abdominal or pelvic pain
- Non-cardiac chest pain
- Functional neurological disorder (FND)
- Chronic headache syndromes
Importantly, functional pain is not “all in the patient’s head”. It’s a product of the brain and nervous system responding in a maladaptive way — often shaped by prior injury, stress, trauma, or repeated pain episodes.
Why This Conversation Matters
When a patient hears, “There’s nothing wrong with you,” they don’t feel reassured — they feel dismissed. The absence of findings doesn’t mean the absence of a problem.
As GPs and allied health professionals, our role is to help patients:
Understand why their pain is occurring
Feel believed and supported
Shift from searching for a diagnosis to building strategies for recovery
Communicating About Functional Pain: A Step-by-Step Guide
Step 1: Validate First, Always
Start by acknowledging the reality and impact of their pain — regardless of the cause.
“I can see this pain is really affecting your life. It’s clear you’re not making this up — and I believe you.”
Step 2: Offer a Modern Explanation
Avoid outdated language like “psychosomatic” or “medically unexplained.” Instead, explain pain as a nervous system issue.
“Your pain system — which involves your nerves, spinal cord and brain — can sometimes become overly sensitive. This means you feel pain even when there’s no ongoing damage.”
You might use metaphors:
A car alarm that goes off too easily
A volume dial stuck on high
A brain prediction error, where the brain interprets normal signals as danger
These help make the invisible feel understandable — and less frightening.
Step 3: Shift the Focus to Function
Let patients know that moving forward is possible, even if the pain persists.
“We may not be able to ‘find and fix’ one clear cause, but we absolutely can work together on a plan to help you feel better and function more.”
This is often the first time patients hear that recovery doesn’t require total pain elimination.
Step 4: Introduce the Team Approach
Patients with functional pain benefit most from multidisciplinary care — including psychology, physiotherapy, and lifestyle interventions.
Clarify the roles:
Psychologists: to help regulate the nervous system and reduce pain-related distress
Physiotherapists: to gently reintroduce movement and reduce fear-avoidance
OTs/exercise physiologists: to rebuild confidence and function in daily activities
Position this support as strength, not a sign that something is “wrong mentally.”
Step 5: Prepare for Pushback — With Kindness
Some patients may resist the idea of functional pain — especially if they’ve faced stigma in the past.
Be ready with language like:
“I know it’s frustrating not to have a scan or test that explains this perfectly. But your pain is real, and the way your nervous system is working gives us a roadmap to help — even without a structural injury.”
What Not to Say
“It’s all in your head.”
“Just relax and it’ll go away.”
“There’s nothing wrong with you.”
“Maybe it’s just anxiety.”
These phrases — even if well-intentioned — are dismissive and alienating.
Rebuilding Trust, Reframing Recovery
Many patients with functional pain have been to countless appointments and left feeling more confused or ashamed. Your ability to hold space for the reality of their experience — while gently guiding them to a new understanding — is often more therapeutic than any medication.
Talking about functional pain is delicate but essential. With the right approach, clinicians can turn a moment of potential dismissal into a breakthrough of understanding.
By validating the pain, offering a modern explanation, and focusing on function rather than fault, GPs and allied health professionals can help patients let go of the exhausting search for a diagnosis — and begin the far more hopeful journey toward recovery.
