Somatoform pain disorder symptoms, causes and therapy

Physical complaints from mental pain

Somatoform pain disorders are mental disorders in which patients experience physical pain. The psyche has a significant influence here. The following article tells you everything about causes, treatment options and symptoms.

contents

• Physical complaints from mental pain
• What is pain?
• The psyche and the practice
• The brain sends and suppresses pain
• The somatoform pain disorder
• The psyche hurts in the body
• Pain, sadness and despair
• Stress leads to pain
• Pain as a psychophysical alarm
• Psychotherapy as a pain cure
• Living with the pain?
• How to recognize the physical pain of the soul?
• Epidemiology
• What should the doctor pay attention to?
• Criteria for the diagnosis
• What other mental triggers come into consideration??

What is pain?

Pain refers to unpleasant sensations that can damage tissues. Pain is not just a sensual, but also an emotional perception.

In a somatoform disorder, the person experiences physical complaints for which no physical cause can be found. (Image: deagreez / fotolia.com)

The International Society for the Study of Pain explains:

1) The emotional component of the pain is equated with the sensory.
2) Pain is a subjective experience, not objectifiable.
3) Tissue damage and pain response are no longer considered pain category: tissue damage is neither a sufficient nor a necessary condition.

The psyche and the practice

In practice, many doctors and sufferers lag behind the current knowledge about the interaction of psyche and body in pain. They still regard pain only as a signal.

According to the traditional understanding, only sensory stimuli led to pain: the more intense such a stimulus is, the greater the pain. So, in the past, physicians used to tell patients who reported great pain without tissue damage to hypochondriacs, or patients who imagined the pain.

Yet this "training", taken literally, is not at all wrong: it means that mental problems trigger pain as well as sensory stimuli. So if you "only" imagine a pain, you can feel just as much pain as someone who is exposed to strong sensory stimuli.

The brain sends and suppresses pain

Conversely, even pain as a result of intense sensory stimuli perceive people very differently. An example of everyday life that each of us knows are injuries that we only feel pain when we see them.

The brain even suppresses pain in extreme injuries. The so-called shock ensures that the extent of the damage does not arrive as pain in the consciousness. Paramedics know, for example, accident victims who cleaned the front window of their completely destroyed car with their abdomen open.

The somatoform pain disorder

For some mental disorders, pain is the leading symptom. The "persistent somatoform pain disorder" is characterized by severe pain either in one area of ​​the body or in several, in the head and in the abdomen, in the chest, abdomen or shoulder.

In addition there are fatigue / exhaustion, dizziness, gastrointestinal problems, excessive sweating, inner restlessness and tachycardia.

In addition to pain, other symptoms such as Fatigue, tiredness and dizziness. (Image: 9nong / fotolia.com)

Patients often visit one specialist after another, as they also seek a physical cause of their physical pain. Although they are mostly aware of their mental health problems, they do not consider them to be the basis of their physical suffering.

They also suffer because one doctor after another states: "Everything is alright with them." Those affected often go into a vicious circle because they continue to feel the pain, but they see themselves as hypochondriacs who only condone their complaints. Desperation grows.

Medically, there is no question today that the pain of the "soul sick" are real.

The psyche hurts in the body

Patients suffer from impaired pain and stress management. They are generally more sensitive to stress and pain than other people.

German terms such as "pain of the soul" or "heartbreak" show that the vernacular has always thought of physical and emotional suffering together.

The neurosciences can explain why this is so today. Pain is a sensation, without this sensation it does not exist. The pain arises in the brain in the very areas where the feelings are formed.

Pain, sadness and despair

So pain is a feeling like sadness, anger, or joy, and all these feelings in turn affect the pain.

Negative feelings, the experience of loneliness, lack, loss and social pressure, emotional neglect or physical abuse, can be the cause of chronic pain.

Exclusion, for example, as workplace bullying or mental terror, such as job centers on Hartz IV addicts, activates the pain centers in the brain.

If someone feels "hurt" because someone insults, harasses or discriminates against him, then he is hurt. His mental injuries trigger pain as well as physical injuries.

Stress leads to pain

Circulation measurements in the brain show that exclusion and sensory stimuli have the same effects. Martin von Wachter of the German Pain Society writes: "If you simulate e.g. A computer game in which the test subject is suddenly no longer allowed to play an exclusionary situation reveals an activation of the brain areas (neural network) that are active in physical pain. "

Research has shown that the same feeling of exclusion activates the same areas in the brain as it does with physical pain. (Image: imaginando / fotolia.com)

Not only that. Von Wachter writes: "Pain and negative feelings can be reactivated later in life through physical or psychosocial triggers, such as frequent conflicts, prolonged work or family overwork, or exclusion in the form of workplace bullying. "

According to Von Wachter, this is by no means a matter of subjective impressions: "By closely linking social and physical stress-pain systems at the neurobiological level, exclusion is not only subjectively experienced as painful, but also leads to the activation of pain areas in the brain . "

Pain as a psychophysical alarm

The brain does not separate between body and psyche. Wachter writes: "It is probably a common alarm system. This alarm system warns by the same means not only of an imminent loss of social contacts (such as group affiliation), but also of bodily injury. "

At the same time, the brain does not immediately raise the alarm when it comes to bodily injuries when the affected person is well all together, because positive feelings dampen the pain or do not even allow it to arise.

Who does not know the situation of lying in bed with throbbing temples, barely able to sit with stomachache while the pain disappears as we celebrate with our friends?

In evolution, it was extremely important to activate the alarm in the brain in both physical injury and social exclusion, as physical integrity and social relationships in the group were both necessary for survival.

Psychotherapy as a pain cure

People who suffer from a somatoform pain disorder need psychotherapy. It is about changing the perception of the pain, respecting the associated feelings and distinguishing them from the pain.

Therapist and sufferer try to express these feelings, such as sadness, repressed hate or anger, other than pain. At the heart of the therapy are interpersonal relationships. Which relationships in the workplace, which friends and acquaintances do the affected person good, which activate their suffering? Who should be separated, which relationships should they deepen, change or rebuild??

Patients reflect their expectations of themselves and others. For example, the pain may be that a person in his childhood could never be "good enough" towards the parents, no matter how hard he struggled. Now the pain comes in, because he still fears at work and in the partnership that he can not give enough.

In psychotherapy, sufferers learn to pay attention to their own needs and protect themselves from excessive demands. (Image: Photographee.eu/fotolia.com)

Many sufferers lack self-care. In therapy, they learn to recognize their own behavior and the expectations they place on themselves and others, and thus take their own needs and wishes seriously. This allows them to protect themselves from situations that overwhelm them and thus trigger pain.

A prudent therapist also talks to the patient about the events, losses, conflicts and humiliations of the past that still burden him today. Relief means with soul pain: The pain subsides.

Living with the pain?

The therapy is not intended to "live with the pain", but to work on the psychosocial situations that underlie them. Therapy forms in which the patients can express themselves complete the conversation with the specialist: Therapeutic painting and therapeutic writing are just as suitable as body, music and art therapy.

In contrast, painkillers are unsuitable. They usually do not relieve the pain, however, antidepressants can help patients to look at them from a distance, since the depressive moods are the same for them as the pain.

How to recognize the physical pain of the soul?

For the diagnosis, the pain symptoms must last at least six months and be physically unexplained. In addition, they should be in temporal context with a psychosocial crisis.

Did the patient suffer a fatal blow? Died a relative, he lost his job, separated his partner from him?

Is the person affected under permanent psychophysical stress? Do you care for a sick relative, do you work in the care of the disabled, in the hospice etc.? Is being bullied at work?

Did the symptoms start earlier? Are there early psychological strains behind it? Divorce of the parents, violence in the family, alcohol abuse, marginalization in school?

One cause of mental anguish may be early psychological distress, such as the divorce of the parents, his. (Image: weerapat1003 / fotolia.com)

Is there an internal conflict that puts a burden on those affected? For example, can not you reconcile your job as a Job Center employee with their humane ethics??

For example, a 54-year-old has been suffering from pain in various parts of the body for eight years. Her husband is an alcoholic, controls her permanently; she has to justify herself as she puts on clothes, why she comes home five minutes later than expected.

He determines what she does. He speaks even in a diagnostic conversation, not her. Before marriage, she was also suppressed in her parents' house and pressed into a rigid system of rules. Her mother later sided with the terrorizing husband in every conflict.

All painkillers, even morphine, remained ineffective.

Epidemiology

There are no quantitative surveys of somatoform pain disorders overall. Doctors suspect that up to ten percent of all pain patients suffer from it.

What should the doctor pay attention to?

The victims are usually noticed by their behavior. Thus, they describe pain more with emotional and moral terms than with neutral ones: instead of calling a pain "burning" or "oppressive," they speak of "terrible," "disgusting," or "disturbing.".

In young women, the pain often occurs in the forearms and knees. Such patients are in a double bind, they can not detach themselves from their parents, but want to be independent and have symptoms that express this: it hurts to stand on their own feet or to put things in their own hands to take".

Similar "expression pains" are shown by patients who report flat rates to the doctor about their "happy childhood" until a trained therapist discovers physical maltreatment or sexual abuse behind the façade, but who then deny or trivialize it for as long as possible.

These patients usually complain of a "lump in the throat", tightness and suffocation as well as abdominal pain.

Criteria for the diagnosis

• There is no somatic pain cause.
• The symptoms started before the age of 35.
• Those affected describe the pain relatively vaguely.
• The pain intensity is permanently high without free intervals.
• The patients describe the pain with judgmental adjectives.
• The pain often starts locally and expands greatly.
• The pain does not adhere to the anatomical limits of physical pain.
• Scientists of various disciplines can only make the diagnosis together and all involved must be trained in the psychosocial understanding of pain.
• Psychosomatic relationships are part of every conversation with pain patients right from the start, and as a measure they must be of equal importance as the neurological and orthopedic examination.
• The most important diagnostic procedure is the analysis of biographical factors. To 80 - 90% they can be differentiated from organic pain syndromes.
• Are conflicts of partnership the cause of a diagnostic couple talk appropriate, since a history of foreigners because of the psychodynamics of the disease endangers the cure.

What other mental triggers come into consideration??

The somatoform pain disorder is easier to distinguish from organic pain syndromes than other mental illnesses.

These are: somatoform autonomic dysfunction, somatization disorder, post-traumatic stress disorder, depressive disorders, anxiety disorders, hypochondriasis and hypochondriacal delusion, as well as coenesthetic psychosis.

Even patients with muscle tensions that have psychosocial causes, do not fall under the somatoform pain disorder. Likewise, it is not about people sabotaging healing processes through affects, such as catastrophizing or fatalism. Furthermore, pain patients who suffer from mental disorders due to their organic suffering are not included in the diagnosis. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)