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Psychological Pain: Medical Ramifications of an Evolutionary Perspective
Like pain resulting from bodily injury, psychological pain likely serves an adaptive functional role in the human body's defense system. Although such pain is manifested physically, it may not be possible to treat the underlying causes of psychological pain in a medical setting. However, because the symptoms can be treated medically, the underlying social conditions, if not acute, may persist and perpetuate the need for medication. If chronic pain is viewed as a disorder rather than a functional mechanism, the underlying causes of such pain may remain unaddressed by medicated patients and/or their doctors.

Defense Function
Pain is part of the body's defense system, and can motivate behaviors that mitigate current physical harm and prevent future harm. For example, touching a hot burner stimulates nerve fibers in the hand causing pain and a reflexive recoiling behavior. The association of the behavior (touching a hot burner) and its painful consequence in memory helps prevent re-injury. When physical cause is apparent, the evolutionary function of pain is also quite apparent. This association is helpful in medical contexts where pain is often thought of as a symptom of physical injury and can be useful for diagnosis. However, because of the associated discomfort, doctors commonly prescribe medications to relieve pain during the post-treatment healing process. Although such treatment ignores the function of pain as a defense against re-injury, pain relief can allow individuals to resume normal activities if the source of the pain is adequately protected from re-injury, e.g., bandaging and/or immobilizing affected areas.

Motivational Function and "Psychological" Origin
Pain is not only associated with physical injury. It can also serve as motivation to fulfill other biological needs. For example, the discomfort of hunger motivates one to eat. Hunger can result from an empty stomach but might also arise while simply listening to a description of food. Pain from muscle tension is often associated with stress and activation of the fight or flight response. Some authors consider pain a negative consequences of over-reactive adaptations functioning in abnormally (evolutionarily speaking) stressful social environments. Regardless of their adaptive function, these brief examples demonstrate that pain, even in common forms, can arise from environmental perceptions unassociated with direct physical contact or injury.

Psychological Pain and Disorder
Psychological pain, commonly referred to as psychogenic pain, psychalgia, or non-specific pain is often distinguished from nociceptive pain (physical stimulation of nerve fibers) based on the apparent absence of tissue damage. Pain is often a symptom of stress and emotional conflict, and is common to mood disorders such as anxiety and depression. From an evolutionary psychological perspective, the frequency with which these disorders occur suggests they result from psychological adaptations (e.g. see Evolutionary Approaches to Depression), but they may have maladaptive outcomes, e.g., major depressive disorder, associated with environmental misfit. In other words, the adaptations underlying mood disorders likely evolved within human social contexts quite dissimilar to some current human social environments. Because pain is a common denominator among these disorders, and is even associated with everyday social stress, one can reasonably assume that psychological pain has an adaptive function to motivate action or withdrawal. Behaviors are often deemed disorders if the persist longer than expected. Like prolonged or extreme disruptions in mood, chronic pain is given a clinical definition and disorder status in the American Psychiatric Association's Diagnostic and Statistical Manua l, and is often positively correlated with Major Depressive Disorder (though the causal relationship is unclear and may be bi-directional).

Functional Assumptions in Medical/Clinical Treatment
In a medical context, psychological pain can be problematic because of the absence of an apparent cause. Since psychological pain is physically manifested, it can be treated in the same ways as any other pain, but medical doctors cannot treat the underlying cause(s) of the pain. If patients are referred to doctors of psychology, clinicians may help resolve chronic pain through cognitive behavioral therapy. However, if therapy is focused on pain relief rather than addressing the underlying causes of psychological pain, the condition may persist. If chronic pain, like prolonged changes in mood, is simply thought of as a disorder, medical and/or psychological doctors may focus exclusively on pain relief rather than pain remediation, especially if medication relieves symptoms. If pain is approached from an adaptive evolutionary perspective rather than as an ailment that can be treated with medication, it is inherently more likely that the environmental cause of pain will be identified and mitigated. This approach does not preclude the possibility of disorder/disfunction/dysregulation, but reduces the likelihood that such diagnoses prevent the mitigation of identifiable environmental causes of psychological pain.