The diabetic with neuropathy can experience pain due to spontaneous firing of damaged nerves. The quality is typically burning and often there is a paroxysmal quality such as shooting, jabbing or shock-like pain. Muscular pain is pulling, tight or aching. Certain movements or positions may accelerate or trigger muscular pain. The location is frequently drawn by the patient on a pain diagram in a pattern that coincides very closely with the affected muscles.
Psychogenic pain is pain that originates through cognitive and emotional processing.
Examples are conversion disorder, factitious disorder, and somatization disorder. Such scales and formalized intensity ratings are important in a hospital setting where care is delivered by many, and where doses and drugs are continually changing. In chronic pain management, intensity scores play a lesser role to the role of assessing impairment, function, impact of pain and relative improvement in pain. In most cases, successful management requires a comprehensive approach, utilizing not only sequential drug trials but also intense physical and psychological rehabilitation. Complementary approaches such as biofeedback, relaxation, acupuncture, and hypnosis are also useful in some cases.