Psychogenic pain

Psychogenic pain is not a sign of any mental illness, nor is it a symptom indicating a true organic pathology. Rather, it is a set of painful sensations associated with the type of mental structure of a person - asthenic, hypochondriacal, depressive.

Pain caused by a neurotic factor is a kind of compensation, a response to various psycho-emotional circumstances, situations and is not associated with functional damage to organs or systems. Mental trauma, acute or suppressed, manifests itself as anxiety, fear and most often chronic headaches, back pain and abdominal pain.

In the International Classification of Diseases (ICD-10), psychogenic or neurotic pain is defined as follows:

F45.4 – persistent somatoform pain disorder

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Causes of psychogenic pain

The etiology and causes of psychogenic pain have not been sufficiently studied, but are definitely based in the psychological field, since they have a clear cause-and-effect temporal connection between the pain symptom and an unconscious, secondary benefit. One of the most obvious reasons is pain as a way to get the missing attention and sympathy, which, in the patient's opinion, cannot be attracted in other ways.

The causes of psychogenic pain can be divided into two categories: internal and external:

1. Internal – innate or acquired qualities, properties of response to psycho-emotional stress, negative events, relationships. Methods of response are most often formed in early childhood, and are subsequently regulated by the limbic system, reticular formation (subcortical centers).
2. External causes are a micro-society that forms the emotional component of a person, behavioral habits, skills that are transferred from childhood to adulthood. Also, one of the external causes can be the so-called rigid upbringing (strict framework), in which any manifestation of emotions, reaction is prohibited.

The following main causes of psychogenic pain are identified:

• Psychodynamic sphere. Pain is interpreted as a way to get attention, care, love, with the help of complaints about pain, one can avoid punishment, punishment or compensate for the feeling of guilt for a mistake, misdeed. This factor is formed in early infancy and is fixed in childhood •
• Defense mechanism – repression, substitution, displacement. Unconsciously, a person identifies himself with an object that is significant to him and, literally, is more together with it.
• A factor of reinforcement of pain, which is encouraged by care, but can decrease in intensity in case of neglect or punishment. The codependent complex pain - encouragement of pain can develop over many years.
• A factor of interpersonal communications, relationships, when pain is a means of manipulation and a kind of secondary benefit for the patient.
• A factor associated with the functioning of the nervous system and the neurological status of a person, when distress provokes a change in general blood circulation, metabolic processes, and arterial pressure. The consequence is irritation of pain receptors and the formation of reactive shifts that are threshold for the central apparatus of the brain. Thus, fear, affect is accompanied by vascular and muscle spasms, provoking pain.

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Symptoms of psychogenic pain

The clinical picture of somatoform pain syndromes is very similar to the symptoms of organic pathologies, since mental structures often support and even provoke organic pathologies. One of the typical differential signs is the inability to relieve pain using standard therapeutic schemes; in addition, psychogenic pain can be treated with antidepressants.

• The main symptoms of psychogenic pain:
• Multiple, recurring and changing localization of pain over the course of six months. There is no objective, confirmed by examination, somatic cause of pain.
• The pain has a different character, it can be aching, pulling, sharp, cramping, burning. The pain changes its intensity and localization regardless of the medication, and the duration or irradiation of pain does not depend on the medication.
• Psychogenic pain is usually accompanied by a depressed state, irritability, and depression.
• The pain is not relieved by anti-inflammatory drugs or analgesics, but can subside under the influence of favorable psycho-emotional factors.
• The pain is anamnestically associated with a stressful situation, conflict, or social problem.
• A person suffering from psychogenic pain constantly changes doctors, he develops a skeptical attitude towards medicine in principle and distrust of its capabilities.

Symptoms of psychogenic pain can be detected in any organ or system, but most often patients complain of abdominal pain, headache, and psychogenic pain often manifests itself in the form of skin itching.

In a diagnostic sense, the following complaints are typical for somatoform pain disorders:

• The whole body hurts, the whole head hurts, the leg, the back, the stomach, that is, there is no clear localization of the pain zone, it seems to be constantly migrating.
• Lack of effect from treatment.
• Oddities in the description of subjective sensations on the part of the patient.
• Multiple crisis situations.
• Demonstrative personality traits of the patient.

Psychogenic headaches

One of the most typical neurotic pains is tension headache.

Psychogenic headaches are provoked by stress, traumatic situations, and depressive states. The clinical picture of such pain is not specific, but in clinical practice there is a fairly clear differentiation - tension headache and pain associated with anxiety or hypochondriacal conditions. Most often, patients suffer from neurotic pain for a long period and seek medical help when all independent treatment methods have already been tried and do not bring relief. Such actions only worsen the patient's condition, as they form a persistent belief in the impossibility of recovery and provoke fear of developing a non-existent disease.

Psychogenic headaches can be pressing, aching, paroxysmal, most often it is difficult to determine their localization, but they are rarely one-sided. This can be a differential sign that distinguishes psychogenic from true migraine, which is characterized by a one-sided pulsating character.

As a rule, neurotic headaches affect impressionable people, anxious and suspicious from the start, their empathy, emotionality for various reasons does not find an outlet, manifesting itself in the form of pain. In addition, elementary physical or intellectual overstrain, chronic fatigue can also be factors that provoke psychogenic pain.

Diagnosis of neurotic headaches is difficult, first of all it is necessary to exclude organic pathologies and injuries, including hidden ones. The main diagnostic method is long-term surveys, collection of anamnesis, including family, social, involvement of psychotherapists, neuropathologists in the examination, as well as physical methods, which most often reveal chronic muscle tension of the neck and head.

Psychogenic abdominal pain

Abdominal neurotic pain or abdominalgia is most often diagnosed in patients with a demonstrative personality type. Psychogenic abdominal pain manifests itself in spasms, colic, IBS (irritable bowel syndrome). Cardiospasms and chronic vomiting are also typical for ablominalgia. Psychogenic abdominal pain is often diagnosed in patients with anorexia, for whom pain is a reason and argument for refusing to eat.

Among the factors that provoke psychogenic abdominal pain, psychological traumas, most often received in early childhood, are in the lead. Over time, the child gets used to demonstratively drawing attention to his personality in this way, an adult already unconsciously reacts with abdominal pain to social conflicts, problems in the team, family. Despite the demonstrativeness and egocentrism, such a person is extremely suspicious, anxious and very sensitive to the manifestation of attention, care.

Diagnosis of abominalgia, unlike psychogenic headaches, is simpler, since the absence of organic pathologies is determined quite quickly and clearly using ultrasound, FGDS and laboratory tests.

Treatment of psychogenic headache

Neurotic pain, including headaches, is not a serious disease that requires inpatient treatment, however, despite all the harmlessness, the treatment of psychogenic headaches is a long and difficult process.

Having ruled out organic brain damage and other pathologies, the doctor may prescribe drugs belonging to the group of psychotropic drugs, antidepressants, central muscle relaxants and additional methods. The effectiveness of physiotherapy procedures has not been proven, although their use can help speed up recovery. Acupuncture and manual therapy give good results if the patient is diagnosed with tension headaches not associated with a psychoemotional factor.

Treatment of psychogenic headaches also involves a long course of psychotherapy, at least six months, during which the patient, continuing to take antidepressants, learns the principles of autogenic training, relaxation and self-regulation. Good results are achieved with the help of body-oriented psychotherapy, when unreacted and suppressed feelings, emotions, clamped in the body in the form of muscle blocks, are removed, and the person feels noticeable relief.

Treatment of psychogenic abdominal pain

If, with the help of diagnostic measures, the doctor excludes pathology of the abdominal organs, treatment of psychogenic abdominal pain consists of the following actions:

• Prescribing antidepressants (fluoxetine, amitriptyline, prozac, paroxetine or others).
• Prescription of muscle relaxants.
• Desensitizing drugs are the latest generation of antihistamines.
• Acupuncture aimed at reducing muscle tone.
• Long-term course of psychotherapy, including hypnotic techniques. Behavioral therapy, body-oriented method is effective.
• Training in autogenic training and relaxation techniques.

In the treatment of psychogenic abdominal pain, it is important to follow the medication regimen and attend psychotherapy sessions. Regardless of whether the pain subsides or not, the patient needs to complete the prescribed course to form a compensatory behavior model, consolidate the ability to control sensations and manage emotions at a reflex level.

It is also important to complete the treatment process, which is rare, since patients, having felt relief, stop visiting the doctor, believing that the treatment of psychogenic abdominal pain is finished. The end of therapy can be a stable remission of at least 3 months. It should be noted that patients suffering from abdominalgia may have relapses associated with another stressful situation. In this case, the course is resumed and repeated in full.

Prevention of psychogenic pain

Obviously, the main prevention of psychogenic pain should begin long before birth, when the mother is carrying the fetus. If the conditions for the pregnant woman are adaptive and favorable, the baby develops an adequate nervous system, and further prevention is a positive family environment and reasonable upbringing.

Almost all factors that provoke psychogenias relate to the period of childhood. Of course, the neurotic component of psychogenic pains can be corrected both at the stage of growing up and in adulthood, but these processes are difficult, last for a very long time and are accompanied by a certain resistance on the part of the patient, who strives to preserve his unconscious secondary benefit.

Prevention of psychogenic pain can also consist of simple rules that are familiar to many, but few follow them:

• Compliance with the norms and principles of a healthy lifestyle, giving up bad habits.
• Physical activity, sports, fitness, gymnastics.
• Study and regular application in practice of relaxation techniques, mental relief, and anti-stress techniques.
• Timely visit to the doctor if you experience signs of illness, and the habit of undergoing regular medical examinations.

If a person maintains a positive outlook on the reality around him, learns to respond competently to changing circumstances and express his emotions and feelings, then the saying “all illnesses come from nerves” will not have the slightest relation to him.