Psychiatric Aspects of Pain

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Abstract
The specific sensory experience of pain is dependent not only on the integrity of the neural pathways which mediate it, but also on the emotional status of the individual, which influences the thresholds for both pain perception and reaction. Pain as a psychogenic symptom can occur in almost the whole gamut of psychiatric syndromes and has a different genesis, meaning, and significance in each. The psychopathology varies from mild to severe and can point to states of little regression or to those of far-reaching regression with a correspondingly increasing depth of fixation and poorer prognosis therapeutically. Emotionally induced or furthered painful sensations may result from situations which are essentially external or environmental in origin; or in various types of anxiety states; or in the hysterias; or with obsessive or sadistic implications; in psychosomatic states; as a sign of the perversion of masochism, of addiction, or of hypochondriasis; or in relation to psychotic states. Each has a different significance. Often an individual case has characteristics of more than one category. Pain has a protective function, plays a part in reality testing, and acts as a safeguard against the traumatic state. Inappropriate reactions to unavoidable pain may take the form of either hyper- or hyporeactivity, and are to be explained by the unconscious psychic meaning of the painful experience, as for example the fact that it may symbolize castration or being abandoned to one''s fate. Treatment of psychogenic pain may be symptomatic or specific and varies considerably according to the underlying psychopathology. Specific therapy is that aimed at the uncovering, understanding, and then adequate solution of the underlying emotional conflict or conflicts which make the symptom necessary.
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