Psychosomatic Pain

When we talk about psychosomatic illness people often think that it means the problem is in their head & so doesn’t require treatment, but it actually means that there is a physical problem, usually chronic, which is very real, but it can be caused or aggravated by psychological & emotional factors. In basic terms, it is where stress manifests itself in the body as physical symptoms. 

There are problems, however, in terms of seeking treatment for these chronic issues:-

 • Incorrect/incomplete treatment - there is still a lack of recognition that many chronic pain issues are caused or worsened by psychological factors, & so treat physical pain but are not addressing the root cause of the problem. Hence the long term chronic pain patient often ends up on various pain medications that they can’t do without because they have become physically dependant on them, with the psychological issues still causing symptoms because they’ve not been addressed(see chronic pain cycle in previous chronic pain posts).This then increases the stress, making the problem worse. 

• Treatment is often delayed because the social stigma attached to mental health & psychosomatic illness still prevents people from seeking help

 • Treatment may also be delayed due to a lack of understanding of the effects of stress on the body 

CAUSES 

• grief 

• a big life change

 • inability to vent emotions will eventually reach an emotional breaking point 

• depression 

• chronic stress eg.PTSD due to trauma Any long term or high levels of stress can weaken the immune system, increasing the likelihood of physical symptoms. 

EFFECT OF TRAUMA/ABUSE 

• 40 to 60% percent of women & > 20% of men with chronic pain have a history of being abused 

• the incidence of abuse is 2-4 times higher in chronic pain patients than in the general population 

• those who have suffered severe/frequent/sexual abuse are more at risk of developing syndromes eg.PTSD, fibromyalgia, which are characterized by increased use of medical services, dysfunctional behaviour & a need for validation but often continue to repress painful memories 

• research has shown physiological changes in the brains of those with PTSD, long term depression, history of abuse & fibromyalgia, so abuse may increase pain perception 

SYMPTOMS 

• shoulder /back pain & tension 

• stomach problems 

• headaches 

• pain during intercourse

 • pain during menstrual cycle

 • fast heart rate 

• sweaty palms

 • fatigue after good nights sleep, irritability, abdominal bloating, & menstrual changes are most common symptoms in women 

• chest pain, high blood pressure, & reduced libido are most common in men 

• children often display physiological symptoms of stress due to their inability to communicate feelings eg.stomach ache when being bullied at school 

• teenage stress can often be missed due to major social adjustment & hormonal shifts 

• elderly are prone to depression due to isolation, loss & chronic health problems • compromised immune system – resulting in catching colds & infections & extended recovery times 

TREATMENT

 • identify effective coping mechanisms to manage stress eg. massage therapy which will address both the physical symptoms & the stress itself, support groups, relaxation techniques, regular exercise 

• eliminate unhealthy coping mechanisms, eg high alcohol consumption 

• learn how to express yourself better to avoid holding things in

 • anti-inflammatories - stress can overload the body with chemicals that produce inflammation in the muscles, causing pain 

• consideration of past/present abuse or other trauma eg. military personnel 

• empathy & constructive validation of physical & psychological issues

 • recognition of dysfunctional pain patterns & personality traits 

• documentation of physiological & non physiological features noted during assessment 

• multidisciplinary treatments involving psychotherapy & holistic treatments if indicated 

• offering alternatives to medications that may be potentially habit-forming if possible 

• helping patients understand the relationship between abuse & physiological symptoms in the hope of reducing use of health care services