Psychosomatic Pain : Types, Causes, Symptoms, Treatment, Alternative Therapies

The word psychosomatic has been taken from two different words viz., “psyche” meaning mind and “soma” meaning body. Thus, a psychosomatic disorder is characterized by physical symptoms for which no medical reason could be established. Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV) explains somatoform disorder as the one characterized by “the occurrence of one or more physical complaints for which appropriate medical evaluation reveals no explanatory physical pathology or pathophysiologic mechanism, or, when pathology is present, the physical complaints or resulting impairment are grossly in excess of what would be expected from the physical findings.”

There are various types of somatoform disorders: Conversion disorder, somatization disorder, illness anxiety disorder, body dysmorphic disorder, undifferentiated somatic symptom disorder.

Psychosomatic pain also known as psychogenic pain or pain disorders caused by psychological stress or anxiety and is characterized by chronic pain in more than one area and lasts from months to years. Psychosomatic pain disorder has the following characteristics:

• The pain cannot be explained by a medical condition
• It causes serious distress or impairment or both in various areas of functionality of the individual.
• The start, maintenance, exacerbation and increase in the severity of the symptoms are caused by psychological factors.
• The complaint of pain is not intentional or fake and that it is not caused by any psychological disorder like mood and anxiety disorder, or any other forms of psychotic disorder.

Evidences suggest that somatic pain experienced by children has an equal intensity as that of an adult. Differences in ethnic groups and race are found to prevail in the cases of psychosomatic pain. Moreover, a strong correlation has been found between gender and pain. It is found in many studies that women suffer more from psychosomatic pain than men and that they seek more help. It was also established that children complaining of somatic pain often complain of headaches or abdominal pain. However, with the advancement of age, the pain locations vary and rather they start to experience it in many varied locations and the intensity is also higher.

Psychosomatic pain can be of various types and it can take place in any parts of the body. The pain experienced could be localized to one area or it could be generalized like all over the body.

Moreover, the pain might start from one part and it can spread to other parts of the body too. Some of the common areas are as follows:

• Headaches
• Body pain
• Back pain
• Abdominal pain
• Pain during intercourse
• Painful menstrual cycles
• Pain in the arms.

Many physicians consider fibromyalgia and chronic pain syndrome as a type of psychosomatic pain.

A person is typically diagnosed to have pain disorder if no other medical condition justifies the pain and its intensity or the symptoms doesn’t match with the actual pain. For example, a patient might complain of chronic pain following an injury which has been treated months ago and the pain could not be explained at present by the injury. The diagnosis mainly depends on how the medical healthcare provider defines the symptoms and the psychological factors. However, it should be kept in mind that a psychosomatic pain is not only in the mind of the patient complaining about it as it was thought earlier. They are actual physical pain that is experienced by the patient in real. They aren’t just faking about it. A series of screening like blood tests and radiologic examinations like x-rays, CT scan, MRI would be done to rule out if there is any medical condition behind the pain. If all the tests are found to be normal, only then a diagnosis for psychogenic pain is done. While diagnosing a person for psychosomatic pain or pain disorder, one should keep in mind the following things:

• Family history of psychiatric problems or somatization disorders
• Physical illness of one or both the parents
• Financial status and crisis in the family
• Negative life events
• Being victimized or bullied
• Past history of somatization disorder
• Childhood abuse: physical, psychological or sexual
• Parenting styles
• Secondary gain achieved due to pain
• Increasing of pain following a stressful event
• Subsiding of pain when the stressor has been removed.

Although a definite cause for the onset of this could not be identified, it is thought that certain life stressors might trigger the situation. Many people develop somatic pain after experiencing a significant negative situation like losing a loved one or facing a natural calamity. Some of the common causes of Psychosomatic Pain identified are:

• Abuse: A strong link has been found between childhood abuse and psychosomatic pain. Childhood history of physical, psychological or sexual abuse predisposes a person to getting Psychosomatic pain. However, not every person with a history of childhood abuse develops pain disorders.
• Freudian Concept: As explained in the psychodynamic theories, the unconscious drives or desires, often sexual in nature, which are not acceptable by the society, converts itself into somatic symptoms and releases the tension so that the person does not become aware of the desires and the conscious mind stays at peace. For example, the guilt arising from the unconscious desire is released in the form of pain so that the desire doesn’t cause distress in the person.
• Learning Theories: Often children learn to take advantage of being sick or they start to imitate a near family member to get the pros of sickness.
• Ways of Communication: It is often not possible for a child to describe everything in words. Mostly when under stress they show different somatic symptoms to communicate the distress they are going through.
• Family Influences: Family dynamics including the role of the child in the family and how he is treated by the parents could stimulate the child to show somatic symptoms to gain attention. Moreover, suffering from a psychological disorder might not be accepted in many families or societal structure and the individual might be looked down upon. To avoid these circumstances, many people develop somatic symptoms to gain the support from family and friends.

The best possible way to treat a psychosomatic pain after a definite diagnosis or while diagnosing a case is to refer to a mental health professional. Often many patients would not be ready to accept that the pain they experience is not a physical thing, but the actual cause is a psychological factor. The patient might simply negate to visit a psychiatrist or a psychologist. Thus, a good physician-patient relation is very important in this regard for the patient to seek and continue with the treatment.

The Common Treatments For Psychosomatic Pain Are:

• Counseling & Psychosomatic Pain: Alternatively called as talk therapy, often helps the patient in describing the present situation, the distress it causes to them, the negative effects it has caused in their lives etc. The counselor develops the rapport by validating the symptoms and empathizing with the patient and that’s where the effectiveness of the treatment starts.
• Cognitive Behavioral Therapy To Treat Psychosomatic Pain: It is a form of psychotherapy that focuses on the negative and distorted thoughts, thought blockage, unrealistic beliefs, behaviors that is strengthening the thought-feeling-behavior cycle. It helps the patient in gaining insight on how a negative thought could manifest into a physical symptom and how to break it.
• Non-Narcotic Pain Killers for Managing Psychosomatic Pain: Mild doses of pain killers could be prescribed to manage the Psychosomatic pain initially. However, pain killers often have a long term side-effects and the patient might start abusing it to reduce the pain making the situation even worse.
• Antidepressants For Treating Psychosomatic Pain: Antidepressants could be suggested to relax the patient. The analgesics in the antidepressants often help in relieving the Psychosomatic pain and thus allow the patient to sleep better and in turn reduce the anxiety in them.
• Family and Group Therapy For Psychosomatic Pain: The mental health professional might ask for a family therapy so that a proper support is provided to the patient. The focus mainly stays on communication processes; promote a supporting environment in the family and also to enable in providing appropriate responses to the patient. Group therapy mainly helps is removing the common “why only me” responses to the disorder. It helps in better understanding of the problems and its varieties experienced by other people and also promote communication and socialization.
• Exercise: Regular physical exercise might relieve the Psychosomatic pain and also prevent its aggravation.

The Common Alternative Therapies For Psychosomatic Pain Are:

• Relaxation Technique To Help Overcome Psychosomatic Pain: The various relaxation techniques like guided imagery, progressive muscle relaxation technique etc. helps in relieving the physical and mental stress and relaxes the mind and body. Progressive muscle relaxation technique could be very good for people with body pain as it focuses on contracting a muscle followed by releasing the muscle tension thus easing out the pain to a great extent.
• Hypnosis To Treat Somatoform Disorders: It focuses on resolving the underlying unconscious drives, desires or wishes which is manifesting itself in the form of a somatic symptom. Though there have been a lot of controversies in the technique of hypnosis as a therapy, it has been found to be very useful in treating cases of somatoform disorders.
• Massage: Various massage techniques have been found to give some relief to patients with psychosomatic pain or pain disorders. The forms include chiropractic massage, shiatsu, etc.
• Art Therapies: Art therapies focus on the expression of emotion using different art techniques like music, painting, dance, etc. A body-oriented art therapy is found to do wonders in the treatment of psychosomatic pain disorder. Dance therapy can be of great use since it allows expression of emotion, often conflicting ones, and also the movement helps in relieving pain.
• The other alternative treatments for psychosomatic pain disorder may be hot and cold compressions, distraction techniques, Acupuncture and acupressure, Transcutaneous Electrical Nerve Stimulation (TENS).

Suffering from a psychosomatic pain might be very difficult to explain or communicate to people as there isn’t any physical cause and other might think that the patient is faking. Many a time wrong diagnosis happens due to lack of awareness. Thus a proper guidance from an experienced physician who has treated psychosomatic pain earlier is very important.

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