Pathogenesis of psychogenic pain in the abdomen

The pathogenesis of abdominal pains of a psychogenic nature is associated with the formation of a complex complex of pathological cerebro-abdominal connections (direct and reverse). Affective disorders most often of an anxiety-depressive nature, neurotic nature due to their conjugation with vegetative and endocrine, humoral reactions lead to a violation of vegetative-visceral (gastrointestinal) regulation, while reducing the thresholds of vegetative (visceral) intracep- tive perception. This leads to an increase in anxiety, which further increases autonomic dysfunction. A number of factors, such as hyperventilation, increased neuromuscular excitability, increased motility of the gastrointestinal tract, disrupts the organization of perceptual activity (this was proved by studying the dynamics of sensory and pain thresholds).

Pain in the abdomen, in the pathogenesis of which the leading role is played by mental factors and mechanisms (the first three forms), are the most difficult from the clinical and diagnostic point of view. The close connection of painful abdominal phenomena with mental mechanisms requires, besides excluding organic disease of the abdominal cavity organs, also the ability to conduct clinical analysis using methods other than in somatic medicine. Psychiatric, psychological qualification is very necessary here. The experience of studying abdominal pain of this kind, as well as literature data, makes it possible to single out one criterion critically important for clinical diagnosis, which allows the physician with a psychosomatic orientation to determine, in the context of these abdominal pains, the leading pathogenesis mechanisms of abdominal pain associated with the psychic sphere. We are talking about the existence of a certain continuum of psychogenic and endocrine disorders within the framework of borderline neuropsychic disorders, the leading manifestation of which is the bright phenomenon of abdominal pain. Clinical practice shows that in a complex mechanism of pathogenesis and symptom formation of abdominal algies, "pure" psychogenic and endogenous factors are seldom encountered. Nevertheless, the selection of the predominance of certain factors is necessary at the present level of our knowledge.

Pain in the abdomen of a mixed nature - pain in the pathogenesis of which combines psychogenic and endogenous mechanisms. An important feature of such abdominal pain is the presence in the clinical picture of a number of characteristic moments that to some extent distinguish them from "pure" psychogenic pain. So, for example, in addition to the lack of morphological substratum in internal organs, a number of the selected criteria for positive diagnosis can appear less distinctly. So, the debut of the disease can be detected in connection with or at the same time with the expressed disorders of the emotional sphere (most often depressive series), but without a clear connection with the events of the patient's life. At the same time, one should try to find out "objective" events in the patient's life, to understand what the patient regards as a life stress. It is necessary to find out the significant experiences of the patient and their relationship to a particular situation.

Quite often, the term "pain" refers to different sensations in the main synastopathic circle. Hypochondriac and synestopatic fixation on the abdominal region, as a rule, does not exclude the presence of other sensations in other areas of the body. The most common in these situations are hypochondriacal and depressive manifestations (there may be masked depression). It is important to note that among the manifestations of latent depression, constipation is possible - a characteristic sign of disorders of the gastrointestinal tract.

Analysis of the course of abdominal pain in a number of cases reveals a clear tendency to a certain cyclicity (diurnal, seasonal). An important feature of this type of abdominal pain is considered to be a much less pronounced autonomic disorder. The paroxysmal factor here is minimal, as a rule, it is a question of permanent pain manifestations, often stubborn, monotonous, permanent. The presence of leading abdominal pain syndrome in such patients in the foreground often masks other underlying psychopathological manifestations of endo-reactive nature, and even experienced psychiatrists in some cases, in connection with the presence of an impressive pain phenomenon, come to an erroneous conclusion about the somatic genesis.

The pathogenesis of these pains, in addition to the links reflected in the previous section, includes certain mechanisms that are less dependent on psychogenic influences and associated vegetative-humoral consequences.

Pain in the abdomen as a manifestation of a mental (endogenous) disease. The abdominal area in the population of psychiatric patients who complain of pain ranks third. There are various descriptions of the symptoms of such painful manifestations; they are referred to as "abdominal psihalgii" and emphasize such features of them as the absence of a connection between pain and the topography of organs; variability of localization, intensity, character of pain, unusual descriptions of such pains ("biting", "stitching", "baking", "twisting", etc.). They note the dissociation between the description of pain as "excessive", "unbearable" and a fairly satisfactory general condition of the patient, his mood, appetite, sleep, behavior; They also indicate other mental disorders. The presented characteristics allow one to suspect a mental (psychiatric) disease in patients, in which abdominal pains are only part of the clinical picture requiring qualified psychiatric recognition.

When it comes to a psychiatric patient, one should not abandon the further search for organic causes of pain. After all, the somatic cause, with the likely frequency found in the population, may be in a patient with a psychiatric pathology. In this context, it is important to designate a special form of pathology, when all the aspirations and powers of the patient are directed to the search for non-existent, mythical somatic causes (Munchhausen's syndrome). The most surprising in this case is the fact that repeated sterile surgical interventions do not stop patients in their search. As a rule, such patients always find their "own" doctors, ready to go on repeated operations.

The pathogenesis of the disease in this case, as can be seen from the foregoing, is essentially connected not with the phenomenon of pain, but with the process of mental illness, when "abdominal pain" is some kind of overvalued, delusional idea that organizes the pathological behavior of the patient.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]