Persistent Somatoform Pain Disorder: Causes, Symptoms & Treatment

Some people suffer from diffuse physical complaints and have to hear from doctors again and again that they “don’t have anything”, although they suffer from various complaints. Most often, this is persistent somatoform pain disorder (ASD). Another synonym for the disorder is psychalgia.

What is persistent somatoform pain disorder?

Persistent somatoform pain disorder is a complaint in which affected individuals suffer from persistent pain over a period of months for which there is no organic cause. Usually there is a close connection with psychological stress situations. At least as a trigger, they play a role in the severity and duration. Pain can be felt very strongly subjectively without the affected person simulating it. It determines the whole life and can strongly interfere with work, social contacts, etc. In the long run, persistent somatoform pain disorder can lead to depression and increased suicidal tendencies.

Causes

Persistent somatoform pain disorder is not caused by physical disorders, but rather by the sufferer’s increased perception of pain and stress in relation to other people. Psychological factors play a major role because the seat of pain perception is in the same brain area as emotions. In this way, the perception of pain is coupled with negative feelings such as experiences of lack, loss and exclusion. Many factors can play a role, e.g. problems in the family of origin, real experiences of pain, chronic illnesses, alcohol addiction, separation/divorce, physical violence or emotional experiences of deficiency. Because social and physical sensations are linked at the neurobiological level, pain sensations are triggered simultaneously with negative feelings.

Symptoms, complaints, and signs

There are no leading symptoms in the physical sense for persistent somatoform pain disorder. The most important characteristics are the physical complaints themselves and their duration. The pain persists for a period of at least six months. It is experienced as chronic and severe. The region of the body and the severity can change frequently without any regular pattern. Medical examinations do not find a sufficient physical explanation for the experienced pain. It usually occurs in connection with emotional conflicts or psychosocial problems. There is a wide variety in the exact symptoms, because the disorder can occur in all organ systems. Particularly common are impairments in the cardiovascular system, gastrointestinal tract, genitourinary tract, respiratory system, and muscles and joints. If the cardiovascular system is affected, most patients complain of chest pain, a feeling of pressure in the chest, and heart stuttering or fluttering. The symptoms in the gastrointestinal tract, on the other hand, are hardly distinguishable from irritable bowel syndrome. Here, digestive complaints such as diarrhea, constipation, bloating or flatulence are described. In the bladder area, the main symptoms are a stinging sensation when urinating, frequent urination and lower abdominal pain. Breathing may be affected by shortness of breath and shortness of breath, which can trigger panic attacks. For muscles and joints, the main symptoms are back pain or pain in the extremities.

Diagnosis and course

Persistent pain leads to distress that prompts sufferers to seek medical help. The physician first takes a thorough history because physical abuse experiences often play a role in the lives of those affected. The pain is described more emotionally, less sensory as “burning” or “pulling.” According to the ICD guidelines, the pain must last for a period of 6 months. Psychological triggers must be distinguished from distressing factors that first occurred during the course of the persistent somatoform pain disorder. Pain processes in the context of schizophrenia or depression must not be considered, nor must hypochodric signs. Everybody knows pain. Most of the time they disappear by themselves. In sufferers of persistent somatoform pain disorder, they may appear at a young age, but also at a later age. In those who seek psychiatric help, the pain usually exists for years.For those who, despite the pain, do not make ASD the mainstay of their lives and continue to pursue their work, maintain social contacts, there seems to be a more favorable prognosis than for those who let the disease control them.

Complications

Appropriate and early treatment significantly influences a prognosis for somatoform pain disorder. The earlier this disorder is recognized as such and countermeasures can be initiated, the better the prospects for a pain-free future. This is the only way to prevent the pain disorder from persisting permanently. If the autonomic dysfunction is accompanied by depression and anxiety disorders, psychotherapeutic treatment is also necessary. Individual discussions or even group therapy, are conceivable tools to alleviate the symptoms of this disease and improve the prognosis. In individual cases, however, the duration of the disease is decisive for the course of therapy and the associated prospects of a symptom-free period. As a rule, somatoform pain disorder is a chronic disease because it is not recognized as such and goes unnoticed. The existing symptoms and associated pain are usually seen in connection with physical diseases. Very often examinations and unsuccessful therapies follow. Even if the environment reacts well and recognizes the disease quickly, the road to recovery can be a long one.

When should one go to the doctor?

Those who experience persistent somatoform pain disorder often have an odyssey through doctors’ offices behind them. Many sufferers feel that they are not taken seriously. They therefore avoid further visits to the doctor after a certain point. This is wrong, because these patients should also receive help. If pain is an expression of emotional distress or traumatic experiences, this is no reason to stigmatize those affected. Pain does not decrease as a result. On the contrary, therapy should be much more comprehensive and focus on the suffering person. It is also important to recognize that a persistent somatoform pain disorder can also be attributed to one-sided activities and diagnosed skeletal disorders. Pain that has already become chronic can often be relieved with months of physical therapy. If necessary, adjunctive psychotherapy or conventional pain management may also help. Persistent somatoform pain disorder is treatable. The chronicized pain stimulus can be unlearned, at least in part. It can be counteracted by manual therapies and attempts can be made to identify the triggering causes. Therefore, sufferers should continue to see a doctor until they receive help and are met with understanding. A persistent somatoform pain disorder can, but need not, be a reaction of the body to emotionally stressful situations. In this respect, it is useful if those affected also try to relieve the aching body through self-help measures.

Treatment and therapy

Meaningful with the persistent somatoform pain disorder is a complex approach. Special psychosomatic clinics offer sufferers the option of an inpatient stay and work with different therapeutic approaches. First of all, the patient learns to distinguish between physical and psychological factors and thus to classify his symptoms more clearly. In therapy, we work with the patient to develop a personal explanatory model that also takes into account the psychological factors of ASD, so that those affected do not think they are “crazy” or “mentally disturbed”. Behavioral therapy methods help the patient to change negative thinking patterns, curb avoidance behaviors, and strengthen personal resources. They are often combined with relaxation techniques such as Jacobsen progressive muscle relaxation, autogenic training or biofeedback. Depth psychology sessions are used to work through traumatic childhood experiences, attachment issues and psychological factors. Body, music or art therapy are also beneficial in the treatment of ASD. Treatment with painkillers brings – if at all – only short-term improvement. Rather, antidepressants can still help to distance oneself somewhat from the pain. The main focus is on psychological stabilization.

Outlook and prognosis

Psychotherapeutic treatment may improve the prognosis of persistent somatoform pain disorder.Depending on how complex and how persistent the disorder is, therapeutic interventions range from psychoeducation to long therapies. If the affected person suffers from another mental illness in addition to the persistent somatoform pain disorder, this is usually also treated during psychotherapy. For example, depression, another affective disorder, or a specific phobia often occurs together with the somatoform pain disorder. A physician or psychotherapist often does not diagnose persistent somatoform pain disorder until the patient has been suffering from the condition for some time. One reason for this is the extensive testing required to make the diagnosis: Before persistent somatoform pain disorder can be diagnosed, a primary physical cause for the pain must first be ruled out. Several individual factors influence the prognosis of persistent somatoform pain disorder. Social stressors may cause the persistent somatoform pain disorder to persist longer, affect more areas of the body, or increase the perceived pain. The same is true for psychological stressors, although emotional distress in particular can have a negative impact on prognosis.

Prevention

A useful preventive measure is not to let pain determine one’s entire life and to seek psychological help if no organic cause can be found for physical complaints. A balanced life with social contacts contributes significantly to the stabilization of mental health.

Aftercare

In the case of persistent somatoform pain disorders, physicians usually assume that these have primarily psychological causes. Nevertheless, organic causes are possible or play a role. Skeletal damage or disease may ultimately be the sole culprit for persistent somatoform pain disorder. The psychiatrization of patients is in many cases politically intended. The approach chosen is a matter of paradigms. In most cases, follow-up for persistent somatoform pain disorder has both psychological and physical components. Psychological support may include undergoing a multimodal pain therapy intervention with psychological components, behavioral therapy, or talk therapy. The affected person should learn to better respect his or her physical needs. Many aftercare measures focus on personal responsibility. To relieve the psyche, the workload should be reduced and stress-reducing strategies learned – for example, through resilience training. Moderate sport shows a very good effect on the physical level in the case of a persistent somatoform pain disorder. Gentle sports such as swimming, walking, cycling, yoga or Asian sports such as Tai chi or Chi Gong should be preferred. Prolonged care is also possible by the physiotherapist in the case of a persistent somatoform pain disorder. Rather than being permanently dependent on pain medication or having to take early retirement, long-term physical therapy treatments would be useful.

What you can do yourself

Deep relaxation can help relieve symptoms of persistent somatoform pain disorder. Autogenic training and progressive muscle relaxation are appropriate techniques and are particularly effective if the sufferer uses them regularly. Individuals suffering from persistent somatoform pain disorder can reserve a fixed time during the day to perform the relaxation exercise without time pressure. Mindfulness has a similar positive effect. The goal of mindfulness exercises or meditations is to consciously perceive and accept sensory stimuli without judging them. Relaxation can also occur in the process. Suggestive meditation and (self-)hypnosis can help some sufferers change negative attitudes and thought patterns. Relaxation techniques are not recommended during a psychotic disorder and acute manic episode, as they can lead to worsening of psychotic/manic symptoms. They are also contraindicated during a migraine attack. Since sleep disturbances are a common comorbidity of persistent somatoform pain disorder, self-help may also focus on this aspect.Regular sleep is very important for good sleep hygiene: going to bed at the same time every day helps the body develop a fixed routine. A quiet evening ritual also supports sleep. Immediately before bedtime, quiet pursuits such as painting or knitting are beneficial. Such measures can complement psychotherapeutic treatment and are usually very useful. Persistent somatoform pain disorder is a recognized disease. Affected persons therefore do not have to limit themselves to self-help and small improvements in everyday life, but have the right to appropriate therapy.