The Phenomenon of Chronic Pain
Ronald Schleifer in Pain and Suffering, 2014
Closely associated with the problem and complexity of chronic pain is the focused attention given to neurological processes associated with the phenomena of pain in more recent years insofar as such studies have tried to describe pain in relation to other sensory systems or, alternatively, in relation to larger cognitive systems. At one extreme is the philosophical analysis of pain based upon biological materialism—that is, based upon the neuro-physiology of the brain. Hardcastle nicely articulates this position in her attempt to debunk “two myths about pain”: first, she denies that pain is a subjective state of mind; and second she denies that pain without any physiological corollary—which is sometimes called “psychopathological pains” or “psychogenic pain”—actually exists. (We can define psychogenic pain as “physical pain that is caused, augmented, or prolonged by emotional factors” [Thernstrom 2010: 140]). Both of these myths, Hardcastle argues, assume (often not fully explicitly) that there is “a pernicious dualistic mind/body distinction” in understanding the phenomenon of pain as a form of psychopathology that subscribes to the truth of the psychogenic claim that all pain is subjective. In opposition to this assumption Hardcastle argues “that all pains are physical and localizable and that all are created equal” (1999: 7).
Psychogenic pain
Jennifer Corns in The Routledge Handbook of Philosophy of Pain, 2017
The recent history of the psychiatric diagnosis of “psychogenic pain” is instructive. Before 1980, psychologically caused pain was understood in terms of psychodynamic processes. These concerned the dynamic interaction of emotional and motivational forces that affect behavior and states of mind. Sigmund Freud drew upon the work of Anton Mesmer and Jean Charcot that showed hypnosis could reverse paralysis and other conversion symptoms such as blindness or deafness. Freud interpreted these effects of hypnosis as evidence that powerful unconscious processes could cause physical symptoms like pain (Breuer and Freud 1966). He used hypnosis and free association to uncover and resolve these unconscious conflicts. In the nineteenth and twentieth centuries, psychodynamic forces were used to explain pain and other physical symptoms that could not be explained by observable changes in the body. For example, in 1889 Hermann Oppenheim developed the concept of traumatic neurosis that wedded elements of hysteria and neurasthenia (syndrome of lassitude, fatigue, headache) to explain physical symptoms as the result of physical reactions to fright (Holdorff 2011). In a 1959 paper, “Psychogenic Pain and the Pain-Prone Patient,” George Engel proposed that psychogenic pain arose from guilt and an intolerance of success (Engel 1959). He argued that pain functioned as a substitute for loss or a replacement for aggression. In the 1968 second edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-II), psychogenic pain was codified as part of psychophysiological disorders and described under “painful conditions caused by emotional factors” (APA 1968).
Pain Is a Common Problem
Harold G. Koenig in Chronic Pain, 2013
Chronic pain is common and can be categorized into different types. Physiologic pain results from physical or biological diseases, whereas psychogenic pain results from psychological or emotional causes. Neuropathic pain is a type of physiologic pain that occurs in the absence of ongoing tissue damage, and results from the abnormal processing of pain signals in the nervous system. Psychological and social factors can have an enormous influence on the perception of pain, as can culture, setting in which the pain occurs, personality, expectations, and mood state. Physiologic pain can have a number of different causes. These causes vary depending on a person’s age, activity level, and heredity.
The pharmacological management of dental pain
Published in Expert Opinion on Pharmacotherapy, 2020
Joseph V. Pergolizzi, Peter Magnusson, Jo Ann LeQuang, Christopher Gharibo, Giustino Varrassi
Psychogenic pain is not yet entirely elucidated but it refers to pain with no obvious physical cause and with no local tissue or dental damage. Psychogenic pain, which differs from malingering or fictitious reports of pain, tends to be diffuse and wanders around the body. Psychogenic toothache, like other forms of psychogenic pain, may worsen with stress and does not reliably respond to pharmacological pain treatment. In some cases, a psychiatric referral is preferable to dental treatments, which may not reduce the patient’s pain [66].
An update on the pharmacological management of pain in patients with multiple sclerosis
Published in Expert Opinion on Pharmacotherapy, 2020
Clara G. Chisari, Eleonora Sgarlata, Sebastiano Arena, Emanuele D’Amico, Simona Toscano, Francesco Patti
Psychogenic pain is typically caused or exacerbated by mental, emotional, or behavioral factors and is commonly reported by MS patients with psychiatric comorbidities as anxiety or depression. It has been widely demonstrated that mood dysfunctions and pain are closely related and their coexistence further aggravate the severity of both disorders [19]. This is particularly true as depressive symptoms are present in about a quarter of MS patients [18].
Analgesic hypnotic treatment in a post-stroke patient
Published in American Journal of Clinical Hypnosis, 2021
Caterina Formica, Katia Micchia, Emanuele Cartella, Simona De Salvo, Lilla Bonanno, Francesco Corallo, Francesca Antonia Arcadi, Roberto Giorgianni, Angela Marra, Placido Bramanti, Silvia Marino
Several scientific studies have showed how the hypnotic method could permit the recovery of patient wellness (Häuser, Hagl, Schmierer, & Hansen, 2016). An interesting consideration is that an important external stimulation, such as therapeutic hypnosis, could restore the rhythm of neurogenesis (Rossi, 2003). Other studies have demonstrated hypnosis’ efficacy on cognitive recovery (in particular, memory and patients’ learning ability). The hypnotic trance could be influenced by the “power of words” on the various sites of a genetic cascade and therefore on the subsequent phase of cerebral plasticity, determining a strong therapeutic response (Rossi & Rossi, 2006). This method has been successful in functional recovery and in patients’ quality of life. This process is justified by mirror neurons. Premotor mirror neurons, involved in empathy and understanding of intentions of others (Iacoboni et al., 2005), are now hypothesized as activators of brain plasticity through the dynamic processes of mind-body healing during approaches to therapeutic hypnosis (Gafner, 2005; Rossi, 2002). In recent years, hypnotic suggestions have also been applied to clinical conditions, anxiety treatment, somatization, and post-traumatic stress disorder. Pain is a clear manifestation of illness and usually related to a psychologic illness; for example, conversion hysteria constitutes a largest percentage of the psychogenic pain in a hysteric population (Engel, 1959). Hypnotic analgesia is one of the most clinically useful phenomenon of hypnosis. Other findings have suggested that hypnotic treatments have numerous positive effects beyond pain control (Hilgard, 1975; Hilgard, 1975; Heap, 1995). Neurophysiological studies reveal that hypnotic analgesia has clear effects on the brain and offer information about physiological mechanisms of hypnotic analgesia (Jensen & Patterson, 2014; Patterson & Jensen, 2003). In fact, somatosensory evoked potentials (SEPs) during analgesia highlight an improvement of N140 and N250 components. Hypnotic analgesia have led to highly significant mean reductions in perceived sensory pain and distress (Del Casale et al., 2015). Neuroimaging studies reported neural activity modulated by hypnotic suggestions (Dumont, Martin, & Broer, 2012; McGeown, Mazzoni, Venneri, & Kirsch, 2009). Some evidence has indicated that suggestions of hypnotic analgesia decreased the functional activity in certain areas of the pain matrix.
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