Psychosomatic Aspects of Pain

The mutual understanding of pain is a frequent problem in the patient-doctor relationship. Pain often serves as the first communication of a patient to his doctor and some of the relief for the patient rests upon the physician's ability to accept and understand this communication. Yet the progress of the scientific and intuitive knowledge of pain has been surprisingly slow. Some of the reasons for this are: (1) Disturbances in communication among physicians with a lack of a satisfactory definition of pain, (2) Difficulties for the patient in verbalizing ideas, feelings, conscious and unconscious fantasies about pain, (3) The paucity of attempts to arrive at better understanding of pain as a psychosomatic concept, and (4) The failure to approach the problem in terms of the patient-doctor relationship.

Wolff (39) speaks of how little use physicians have made of pain in establishing diagnoses. He says: “such disrespect had its origin in a generally shared confusion between the sensory perception of pain and the reaction to the painful experience, with its autonomic, emotional and other components. Pain and pleasure were considered opposites. However, while pleasure indicates a reaction of satisfaction, contentment and well-being, pain is a sensation like smell, taste, or vision. It is obvious that a perception and a reaction cannot be contrasted. Although pain usually evokes an unpleasurable reaction, it does not always do so. Once the difference between perception and reaction is accepted, it becomes possible to use pain as a valuable diagnostic instrument.”

Experiments have shown that the pain reaction threshold may vary independently of pain perception threshold, as measured by verbal report, under the influence of analgesics or spontaneously. The pain perception threshold is relatively uniform and stable, and independent of age, sex, emotional state or fatigue. (40) Emphasis will be focussed in this paper on the pain reaction since it is in this area that the problem