The tendency for somatization | Breast Pain Blog

Additive psychiatric diagnoses (such as depression)

According to the concept of "disability pain" somatoform pain syndrome is characterized by a pattern of less typical symptoms, but with a certain experience of physical processing operations ("suffering") and the unfavorable behavior stakeholders disease ("abnormal illness behavior").

Three types of psychological factors in the initiation and maintenance of pain is very important: (a) katastrophisierendes think, (b) anxiety-related pain and fear of pain, (c) a feeling of helplessness. Chronically ill patients learn to cope with using pain cope with their pain, as well as those who accept their pain and not constantly fight it, less affected, depression and anxiety.

Pain disorders often occur in conjunction with other mental disorders (depression, anxiety disorders, post-traumatic stress disorder, sleep disorders). After cross-country WHO study of pain in primary care practice, 34% of patients experiencing pain depression or anxiety disorders. In a psychiatric hospital patient's pain may occur more frequently (to the level of 87% of inpatients).

Pain is often the only symptom of depression or at least presented as the main symptom. Chronic pain is often associated with depression, acute pain, but not with anxiety disorders. Sleep problems usually arise in a decrease in the period and phase 3 and 4 (sleep) REM, that is, the most important stages and most restful sleep.

Proven by many studies are frequently comorbid depression and pain showed that both countries suffer often not for causal models can be explained, but is caused by a third general, psychosocial stress is large in partnership, family, work, and community. Biological factors, such as the serotonergic system disorders that are relevant not only in depression, but also for the modulation of pain is also significant. Patients also suffer under pain disorders and depression are more affected and seek medical care facilities more often than others that have only one of these two disorders. 60% of patients have experienced trauma pain.

Every second pain patients suffer simultaneously from anxiety disorders. Many patients with somatoform pain disorder have a history of functional complaints, such as gastrointestinal or cardiovascular problems.

What is important is the difference of somatization disorder, where even a different experience pain, but compared with other symptoms are not so persistent and especially as a somatoform pain disorder. Persistent somatoform pain disorder can not be diagnosed in the sense of comorbidity Therefore, if the pain is only in the context of somatization disorder, undifferentiated somatoform disorder or somatization autonomic dysfunction (eg irritable bowel syndrome) occurs. The same thing applies sick, as often occurs in the context of major depressive episode (F32 and F33), and pain associated with neurasthenia or fatigue syndrome (F48.0), which is also an acute or chronic muscle pain one of six additional symptoms occur could.

According to the Health Survey 1998 8:14% of Germans have a pain disorder in a year and 12.74% in life - women twice as often as men. Consistent results from different studies to conclude that at least one in ten suffers from chronic pain Germany, in which psychological factors and social tend to have at least some influence. At the top is a headache and backache. According to conservative estimates of experts tend to play an important role in the development, initiation and maintenance of pain associated with psychological factors of persistent pain in 40% of patients. Although pain disorder can occur in all age groups, however, are found most often in the decade of the 4th and 5th of life. Pronounced gender difference is not known.

According to Local Start There is Often a Sharp Increase in Pain

The importance of organic justified pain is evidenced by the Canadian trial involving 1,000 patients medical clinic. In patients who do not have a safe organic causes of their complaints during the observation period of three years, are symptoms of pain in the first place. Among the eight most common complaints are four symptoms.

Some authors (eg, psychoanalyst Egle) defines persistent somatoform pain disorder is much narrower than the ICD-10. Somatoform pain will continue according to this view on the level of pure center, yet isolated from peripheral patient. Pain, which is hard somatic findings in the periphery (myogelosis muscle, "tender points"), will, on this view does not make this diagnostic category, ie all functional impairment, etiology mechanism based on the autonomic nervous system (primary headache and lower back pain, Pelvipathie , fibromyalgia, orofacial pain-dysfunction syndrome) would therefore not somatoform pain disorder. However, the difference between organic and psychogenic pain related considered outdated and not coincide well with the guidelines, but the criteria for ICD research.

People with somatoform pain disorder differ from patients with organ-related pain often in the following ways:

The pain is only vaguely local.

The pain is described rather than affective sensory adjectives.

Usually, there is no difference in pain intensity as a function of day and aggravating factors or other exculpatory.

Among exposure biography can be found in prehistoric times physical violence or sexual abuse.

The problematic concept of somatoform pain DSM-IV

DSM-IV is the problematic concept of somatoform pain disorder and list the following criteria for pain disorders:

1. Pain in one or more anatomical region (s) are at the forefront of the clinical picture and should justify clinical attention for sufficient severity.
2. The pain causes clinically significant distress or deterioration in social, occupational, or other important areas of functioning.
3. The psychological factors are important for the beginning, severity, exacerbation, or maintenance of the pain.
4. Symptoms or failure is not intentionally produced or feigned.
5. The pain could not be better explained and did not meet the criteria for dyspareunia by affective, anxiety, or psychotic disorders.

Pain disorder according to DSM-IV is characterized by pain, which is the focus of clinical attention and in terms of onset, degree, exacerbation or maintenance significantly related to psychological factors. Psychological factors are important both as a cause, trigger symptoms or maintaining factor. The guidelines present in the clinical diagnosis of ICD-10 mind-body dualism tends to be avoided in the DSM-IV, but implicitly there. Psychological factors are not to be understood as a "decisive causal effect" on pain, which is different from the ICD-10 guidelines where they should be dominant and no organic substrate (not even myogelosis muscle) can be given.