What is Psychological Pain?
Psychological pain ile Pain disorder is characterized by pain in one or more anatomical regions according to DSM-IV and requires clinical evaluation. Pain causes a clinically significant distress or impairment of functionality. Psychological factors have an important role in the onset, severity, exacerbation or persistence of pain.
What is Psychological Pain?
Three subtypes of pain disorder are mentioned;
- Associated with psychological factors,
- Associated with both psychological and general medical conditions,
- Associated with general medical condition.
The third condition is not considered as a mental disorder and is coded on the third axis. Pain disorder is classified as chronic if it lasts longer than 6 months and chronic if it lasts longer than 6 months.
When children were admitted to primary care units, recurrent pain complaints were found to be associated with increased psychopathology, impaired functionality, familial difficulties, and high referral to health centers.
The International Association for the Study of Pain (IASP) is defined as an unpleasant emotional feeling associated with past experiences of a person, due to or not due to tissue damage. Since there is no direct or oblique measurement method, the pain must always be evaluated as ‘reported.’ Therefore, it is particularly difficult to assess pain in infants and young children due to their inability to express their problems verbally.
In children younger than 3 months of age, the response to pain is reflexive, often more than 3 months of age with negative affect. In the six-eighteen month period, fear and escape behavior are observed in the child. They begin to express pain in their own words. Eighteen months and older children localize the location of the pain and use the word ‘pain’. In this period, they understand that others may have pains.
Pre-school children may exhibit lap-seeking behavior to alleviate pain. Preoperative cognitive abilities cause pain-related magical thoughts and make it difficult for them to understand the true nature of pain. Children of school age can clearly indicate the severity of their pain. With formal operation, a complex and abstract thought about the course of the pain and its consequences emerges.
Clinical studies have shown that the pain threshold increases with age. It has been shown that younger children are more susceptible to pain caused by medical interventions than children aged 7 and older. In the past, cultural factors have been mentioned in the appearance of pain and pain behavior.
The diagnostic process of somatoform disorders requires the determination of the pain of the child. Because there are no direct and physiological measurement methods, various methods are used to evaluate the pain response. It is useful to determine pain-related behavioral (such as body movements, facial expression) and physiological (heartbeat, respiratory) changes in infants. Observational scales filled by parents or experts, direct grading techniques that can be applied in children younger than five years, pain scales developed for school children and older children can be used to determine the degree of pain. If possible, it is more desirable to report pain experience to the patient.
The effect of the family on pain is not known exactly, but the clinical information and findings show that pain related problems are clustered in certain families. It is thought that the family members of children with possibly unexplained pain have more ‘pain patterns’ than children with a real organic cause. It was determined that the mothers of the young people with pain syndrome who were absent from the school had more pain in their behavior compared to their mothers.
Recurrent abdominal pain (RAA)
RAA is defined as abdominal pain that is severe in the last three episodes, which occurs in the last 3 months and may impair the functionality of the child. This is a very common condition and it is thought to affect 10% to 25% of school children and adolescents. While the ratio of male to female is equal in early childhood, it is more common in girls during late childhood and adolescence. Many cases of RAA have not been explained medically, especially those with pain loss due to weight loss, bleeding, fever, and laboratory findings. RAA is often considered to be a functional gastrointestinal disorder with no explanatory structural and biochemical abnormalities. Most patients meet the criteria for irritable bowel syndrome.
RAA is often associated with other somatic symptoms such as anxiety, depression symptoms and headache. It often leads to school absenteeism. These children are also at risk of undergoing unnecessary medical research. If the examination is complete, the pediatrician should decide. Subsequent discontinuation of the underlying organic disease is another problem.
In the studies, it was found that patients had more emotional and somatic complaints than their normal controls, their families rewarded the behavior of the disease more, but there was no difference in the negative life event and familial functionalities. In a longitudinal study, it was determined that the anxiety level of the parents in the first year of life of the child was related to the subsequent RAA. Again, these children have been reported to have problems in their infancy by feeding and sleeping.
In the past, follow-up studies reported that abdominal pain lasted to adulthood near half of the affected children. At the age of ten, there are studies reporting that children with abdominal pain at 4 years of age complain about similar complaints three times more than their peers. Recent studies have shown that childhood RAAs are predictive of adult emotional disorders.
Reflex sympathetic dystrophy
Although more common in adults, ‘complex regional pain syndrome-reflex sympathetic distrophy’ is seen in children and adolescents. The condition is typically characterized by chronic, painful blisters in the extremities, decreased skin temperature, cyanosis, delayed capillary filling time and functional limitation. It occurs frequently in adults following the damage of the related extremity. However, such a history is rarely detected in children. Furthermore, in children opposite to adults, radionuclide imaging shows reduced involvement in affected extremities.