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Psychogenic pain

Medical expert of the article

, medical expert
Last reviewed: 17.10.2021

Psychogenic pain is not a sign of any mental illness, nor is it a symptom that indicates the truth of organic pathology. Rather, it is a set of painful feelings associated with the type of mental structure of a person - asthenic, hypochondriac, depressive.

Pain caused by a neurotic factor is a kind of compensation, a response to various psychoemotional circumstances, situations and is not associated with functional damage to organs or systems. Mental trauma, acute or depressed, manifests itself through anxiety, fear and more often chronic headaches, back pain and abdominal pain.

In the International Classification of Diseases (ICD-10), psychogenic or neurotic pain is defined in this way:

F45.4 - resistant somatoform pain disorder

trusted-source[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Causes of psychogenic pain

The etiology, the causes of psychogenic pain, have been studied insufficiently, but are unequivocally based in the psychological field, since they have a clear cause-and-effect temporary connection between the pain symptom and the unconscious, secondary benefit. One of the most obvious reasons is pain as a way to get the missing attention and sympathy, which in other ways, according to the patient, can not be attracted.

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

  1. Internal - innate or acquired qualities, the properties of responding to psychoemotional stresses, negative events, relationships. Response methods are most often formed in early childhood, later regulated limbic system, reticular formation (subcortical centers).
  2. External causes - a microsociety, which forms the emotional component of a person, behavioral habits, skills that are transferred from childhood to adulthood. Also, one of the external reasons may be the so-called rigorous education (strict framework), in which any manifestation of emotions, reaction is prohibited.

The following main causes of psychogenic pain are distinguished: 

  • Psychodynamic sphere. The pain is treated as a way of getting attention, caring, love, with the help of complaints of pain you can avoid punishment, punishment or compensate for the sense of guilt for a mistake, a fault. This factor is formed in early infancy and is fixed in childhood
  • The mechanism of protection is repression, replacement, displacement. Unconsciously, a person identifies himself with a meaningful object for him and literally more along with him.
  • The factor of reinforcement of pain, which receives encouragement in the form of care, but can decrease in intensity in case of neglect or punishment. A co-dependent complex of pain - the promotion of pain can develop for many years.
  • The factor of interpersonal communications, relationships, when pain is a means of manipulation and a kind of secondary benefit for the patient.
  • The factor associated with the functioning of the nervous system and the neurological status of a person, when distress provokes a change in the general circulation, metabolic processes, blood pressure. Consequence - irritation of pain receptors and the formation of reactive shifts, which are threshold for the central apparatus of the brain. So fear, affect accompanied by vascular and muscle spasms, provoking pain.

trusted-source[11], [12], [13], [14], [15], [16]

Symptoms of psychogenic pain

The clinical picture of somatoform pain syndromes is very similar to the symptomatology of organic pathologies, as psychic structures often support and even provoke organic chemistry. One of the typical differential signs is the inability to stop pain with the help of standard therapeutic schemes, in addition, psychogenic pain is treatable with antidepressants.

  • The main symptoms of psychogenic pain: 
  • Multiple, repetitive and changing pain localization for six months. Objective, confirmed by surveys, a physical cause of pain is not.
  • Pain has a different character, it can be aching, drawing, sharp, cramping, burning. The pain changes its intensity and localization, regardless of the medication intake, also does not depend on the drugs duration or pain irradiation.
  • Psychogenic pain is usually accompanied by an oppressed condition, irritability, depression.
  • Pain is not stopped by anti-inflammatory drugs, analgesics, but can subside under the influence of favorable psycho-emotional factors.
  • The pain is anamnestically connected with a stressful situation, a conflict, a social problem.
  • A person suffering from psychogenic pain constantly changes doctors, he has a skeptical attitude towards medicine in principle and a lack of confidence in her abilities.

Symptoms of psychogenic pain can be detected in any organ or system, but more often patients complain of abdominal, headache, often psychogeny manifests as a skin itch.

In the diagnostic sense, the following are typical of somatoform pain disorders: 

  • The whole body hurts, the whole head, the leg, back, stomach, that is, there is no clear localization of the pain zone, it seems to be constantly migrating.
  • Absence of the effect of treatment.
  • Bizarreness in describing subjective feelings on the part of the patient.
  • Multiplicity of crisis states.
  • Demonstrative features of the patient's personality.

Psychogenic headaches

One of the most typical neurotic pains is a tension headache.

Psychogenic headaches are provoked by stress, traumatic situation, depressive state. The clinical picture of such pain is not specific, however in clinical practice there is a fairly clear differentiation - a tension headache and pain associated with an anxious or hypochondriacal condition. Most often, patients suffer from neurotic pain for a long period and consult a doctor when all independent treatments have already been tried and do not bring relief. Such actions only aggravate the patient's condition, since they form a persistent belief in the impossibility of recovery and provoke the fear of the development of a non-existent disease.

Psychogenic headaches can be oppressive, aching, paroxysmal, it is often difficult to identify their location, but they are rarely one-sided. This may be a differential sign that distinguishes psychogeny from a true migraine, which has a one-sided, pulsating character.

As a rule, neurotic headaches suffer more impressively people, anxious and hypochondriac in the beginning, their empathy, emotionality for various reasons does not find an outlet outward, manifesting itself in the form of pain. In addition, elementary physical or mental 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 trauma, including hidden ones. The main diagnostic method is long-term interviews, the collection of anamnesis, including family, social, connection to the survey of psychotherapists, neuropathologists, as well as physical methods that most often reveal the chronic muscle tension of the neck and head.

Psychogenic pain in the abdomen

Abdominal neurotic pain or abdominalgia is most often diagnosed in patients with a demonstrative type of personality. Psychogenic pains in the abdomen are manifested by spasms, colic, IBS (irritable bowel syndrome). Also typical for abdominalgia, cardiospasm, chronic vomiting. Psychogenic pains in the abdomen are often diagnosed in patients with anorexia, for which the pain is the reason and the argument for giving up food.

Among the factors that provoke psychogenic pain in the abdomen, psychotrauma, most often received in early childhood, are leading. Over time, the child is accustomed to demonstratively draw attention to his personality in this way, an adult person already unconsciously reacts with abdominal pains to social conflicts, problems in the team, family. Despite demonstrativeness and self-centeredness, such a person is extremely suspicious, anxious and very sensitive to the manifestation of attention, caring.

Diagnosis abominalgiy unlike psychogenic headaches is simpler, since the absence of organic pathologies is determined fairly quickly and clearly with the help of ultrasound, FGDs and laboratory studies.

Treatment of psychogenic headache

Neurotic pain, including headache, is not a serious disease requiring in-patient treatment, however, despite all harmlessness, treatment of psychogenic headaches is a long and difficult process.

With the exception of organic brain lesions and other pathologies, the doctor can prescribe drugs related to the group of psychotropic drugs, antidepressants, central mielorelaxants and additional methods. The effectiveness of physiotherapeutic procedures has not been proven, although their application can accelerate recovery. A good result is provided by acupuncture, manual therapy, if the patient is diagnosed with a tension headache that is not associated with a psychoemotional factor.

Treatment of psychogenic headache also involves a long course of psychotherapy, no less than six months, during which the patient, while taking antidepressants, learns the primes of autogenic training, relaxation and self-regulation. Good results are achieved with the help of the technique 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 a noticeable relief.

Treatment of psychogenic pain in the abdomen

If the doctor excludes pathology of the abdominal cavity with the help of diagnostic measures, the treatment of psychogenic pain in the abdomen consists of such actions: 

  • The appointment of antidepressants (fluoxetine, amitriptyline, prozac, paroxetine or others).
  • Purpose of myelorelaxants.
  • Desensitizing drugs are the latest generation of antihistamines.
  • Needle reflexotherapy, aimed at reducing muscle tone.
  • Long course of psychotherapy, with the inclusion of hypnotic techniques. Effective behavioral therapy, body-oriented method.
  • Training autogenic training, relaxation techniques.

In the treatment of psychogenic pain in the abdomen, it is important to follow the medication regimen and visit psychotherapeutic sessions. Regardless of whether the pain subsides or not, the patient needs to finish the prescribed course to form a compensatory behavior model, to consolidate the ability to control sensations and control emotions at the reflex level.

It is also important to complete the treatment process, which is rare, as patients who feel relieved stop visiting the doctor, believing that the treatment of psychogenic pain in the abdomen is over. The end of therapy can be a stable remission of at least 3 months. It should be noted that patients suffering from abdominal pain 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 prophylaxis of psychogenic pain should begin long before birth, when the mother fetuses the fetus. If the conditions for a pregnant woman are adaptive and favorable, the baby develops an adequate nervous system, and further prevention is a positive family environment and reasonable upbringing.

Virtually all the factors provoking psychogeny are related to the period of childhood. Of course, the neurotic component of psychogenic pain can be corrected both at the stage of growing up and at adulthood, but these processes are difficult, last a very long time and are accompanied by a certain resistance on the part of the patient seeking to retain his unconscious secondary benefit.

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

  • Observance of norms and principles of a healthy lifestyle, rejection of bad habits.
  • Motor activity, exercise, fitness, gymnastics.
  • The study and regular application in practice of relaxation techniques, mental unloading, anti-stress techniques.
  • Timely appeal to the doctor at signs of a malaise, a habit to pass or take place regular dispensary inspections.

If a person maintains a positive outlook on the reality surrounding him, learn to respond to changing circumstances and express his emotions emotionally, the proverb "all diseases from nerves" will not have the slightest relation to him.

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