Alexithymia and pain

In the history of the development of psychosomatic research, one of the central directions is the search for a special mental quality of psychosomatic specificity, which is a factor predisposing to the emergence of psychosomatic pathology, influencing the course and treatment of diseases. The most recent attempt of this kind is the identification and description of the phenomenon of alexithymia, which is considered as a set of features characterizing the mental makeup of individuals, predisposing them to diseases of psychosomatic specificity. It should be noted that in recent years it has been associated with an increasingly wide range of nosological forms (for example, depression, secondary psychosomatic disorders in chronic diseases, etc.) and is characterized in this case as the phenomenon of secondary alexithymia, being a characteristic sign of a severe stress situation.

Alexithymia is characterized by a person's difficulty or inability to accurately describe their own emotional experiences and understand the feelings of another person, difficulties in determining the differences between feelings and bodily sensations, and a fixation on external events to the detriment of internal experiences. Such patients present certain difficulties for the doctor. They cannot accurately characterize (detail) their sensations, including pain. If they are presented with specific possible options (duration, time of day, provoking factors, dynamics of symptoms, etc.), they can usually choose certain options, but this requires much more time for examination and collection of anamnesis than in patients without alexithymia.

In recent years, alexithymia has been considered a risk factor for the development of many diseases, including such common ones as diabetes mellitus, bronchial asthma, gastric ulcer and duodenal ulcer, nonspecific ulcerative colitis, ischemic heart disease, hypertension, alcoholism. There are studies that trace the connection between alexithymia and the risk of fatal cases. The point is that the presence of alexithymic traits in the personality structure of men aged 42-60 increases the risk of their premature death from various causes by 2-3 times. Being a global biological characteristic, alexithymia significantly modifies the psychopathological picture of various diseases.

The predetermining role of alexithymia in the formation of the clinical picture and prognosis of anxiety-panic disorder has been proven, which is reflected in the wide representation of somatovegetative symptoms, algic symptoms, high frequency of panic attacks and rather low efficiency of psychopharmacotherapy. When carrying out therapeutic measures, it is necessary to take into account the low quality of life indicators and high level of anxiety characteristic of alexithymics.

The pathogenesis of alexithymia is associated with disturbances in the paleostriatal tract, resulting in the suppression of impulses from the limbic system to the cerebral cortex. Another point of view postulates a condition when the left hemisphere does not recognize emotional experiences arising in the right hemisphere due to their disrupted interaction. In accordance with this, it was suggested that a person may have a "functional commissurotomy", and alexithymia began to be interpreted as a "split brain" syndrome. Another hypothesis is close to this one, considering alexithymia as a developmental defect of the brain with a defect of the corpus callosum or bilateral or abnormal localization of the speech center in the right hemisphere.

Alexithymia can be secondary. Secondary alexithymia includes, in particular, the state of global inhibition of affects as a result of psychological trauma, which is considered a defense mechanism, although it is not a psychological defense in the classical sense. But it should be taken into account that alexithymic personalities are characterized by the so-called "immature" type of defense, especially with super-strong, unbearable affects for them. The detection of alexithymia in masked depressions and neuroses gave grounds to consider it from the standpoint of neurosis. Alexithymic features are often found in patients with post-traumatic stress disorder, a positive relationship has been established between the level of alexithymia, depression and anxiety.

Alexithymia is more common among men with low social status and income, as well as low level of education. There is a tendency for the frequency of alexithymia to increase in old age up to 34%, while among students, 8.2% of men and 1.8% of women have signs of alexithymia. Alexithymia is a very persistent disorder, requires complex impact, i.e. a combination of psychological and pharmacological correction, which should be aimed not only at reducing the level of psychoemotional stress, anxiety, symptoms of depression, but also at the altered metabolic, immune and hormonal status of the alexithymic personality.

It has been established that alexithymia is not associated with cold pain thresholds, does not correlate with sensory components of pain, but is interrelated with affective perception of pain; there is a relationship between the severity of pain, depression, anxiety and alexithymia in musculoskeletal pain and fibromyalgia. In general, the problem of pain and alexithymia has not yet been sufficiently developed

The 26-item Toronto Alexithymia Scale (TAS), proposed in 1985, is used to determine the severity of alexithymia. Numerous studies by foreign and domestic authors using TAS have proven the stability, reliability and validity of its factor structure and, accordingly, the results obtained. The Russian version of TAS was adapted at the V.M. Bekhterev Psychoneurological Institute (Eresko D.B., Isurina G.S., Koydanovskaya E.V. et al., 1994). When filling out the questionnaire, the subject characterizes himself using the Likert scale for answers - from "completely disagree" to "completely agree". In this case, one half of the items have a positive code, the other - a negative one. People who scored 74 points or more on the TAS are considered alexithymic; a score of less than 62 points corresponds to the absence of alexithymia.

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