Academic journal article Human Architecture: Journal of the Sociology of Self-Knowledge

Trauma in the Mind and Pain in the Body: Mind-Body Interactions in Psychogenic Pain

Academic journal article Human Architecture: Journal of the Sociology of Self-Knowledge

Trauma in the Mind and Pain in the Body: Mind-Body Interactions in Psychogenic Pain

Article excerpt

I. INTRODUCTION

Pain is a multidimensional, complex, and unpleasant experience with emotional, cognitive, affective, behavioural and sensory components (Manchikanti et al., 2002). The word 'pain' is rooted in the Latin word 'poena' which means penalty or punishment (Tyrer, 2006). All people experience pain throughout their lives and more than 80% of patient visits to physicians are because of pain. Pain is defined as an "unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Bob, 2008, p.355). The Joint Commission on Accreditation of Health Care Organizations (JCAHCO) declared that pain is a "fifth vital sign" in January 2001 and also the U.S. Congress has announced the last decade as the decade of "Pain Control and Research" (Rubin, 2005).

Pain is a challenging condition for the patient and the physician, and can make them helpless and flustered. It is a prevalent problem in which 38 percent of psychiatric inpatients and 18 percent of psychiatric outpatients suffer from chronic pain (Griffith, 2008). The sensation of pain is based on two components, sensory pathways and psychological factors (Sarafino, 2007). Many studies have been conducted to discover the mechanisms of pain, such as "gate-control theory" which was described by Ronald Melzack as one of the integrated models that is based on previous work in this field (Melzack, 1999). In this model, there are modulating gates in the dorsal horn of the spinal cord, which is composed of gray matter. These gates receive painful stimuli via pain fibres, and pass them to transmission cells. These cells conduct the pain signal to the brain and then the pain is sensed. The opening and closing of the gates is related to three factors. First, is the level of activity of fibres which conduct pain; this means that, when there is more painful stimulus, the pain fibres become more activated and the probability of the opening of the gates increases. Second, is the activity of other fibres that have a tendency to close the gates; there are some other fibres that conduct the signals of touching, gently scratching and rubbing that reduce the conduction of pain signals. This could be a good explanation for pain reduction strategies that involve using massage or heat therapy in the region of injury. Third, are descending messages that come from the cortex and brainstem to spinal cord. They can close or open the gates. For instance, different brain states related to different emotional states like anxiety or excitement have a general impact, i.e., they close or open all the gates for all inputs in the body but other brain processes may impact some inputs from special areas of the body. Conditions such as low level of physical activity, depression, and boredom can open the gates and circumstances like receiving massage, having positive emotions, and interest in life activities can close the gates. This influence of the brain on the gates can explain the lack of pain sensation in hypnosis or in a condition in which a person is distracted by environmental stimuli (Sarafino, 2007). Pain is also modulated by cognition. The pain experience is influenced by attention, individual expectation, attitude, and emotions. Among these factors, emotions and attention are the most important factors affecting the quality of pain experience. Actually, attention alters the responsiveness of the neurons to painful or non-painful stimuli, and also it can select the pain stimulus and decide to bring painful events into consciousness (Bob, 2008).

Considering this physiological background, in clinical settings one method for the categorization of pain is based on its aetiology. In this manner, there are two main types of pain, organic and psychogenic pain. In organic pain the aetiology of pain is clearly tissue damage, but psychogenic pain lacks a clear physical root. Eighty five percent of patients with back pain lack any identifiable physical cause (Morrison & Bennett, 2006). …

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