A retrospective observational study investigating the relationship between somatisation and pain perception in subjects with intractable pain

Abstract

IntroductionThe aim of this study was to investigate the relationship between somatisation and perception of pain in subjects classified as having intractable pain. MethodsSomatisation features were assessed in 526 intractable pain patients, referred to a psychosomatic clinic between 2002 and 2014 due to the failure of at least 2 pharmacological and 1 surgical/invasive or rehabilitative interventions. The somatosensory amplification (SSAS), illness behaviour questionnaire (IBQ) and the symptom checklist-90 (SCL-90) Somatisation subscale and the other SCL-90 subscales were used to measure psychopathology. The IPQ and cold pressor test (CPT) was used to investigate the perception of clinical and evoked pain stimuli, respectively. ResultsThe principal predictor of an increase in pain perception was age, which was also associated with a greater effect of SSAS and IBQ affective disturbance scores on sensorial and affective dimensions and intensity of pain, and sensorial, affective and cognitive dimensions of pain, respectively. However, high SCL-90 somatisation scores were predictive of increases in sensorial, affective and cognitive dimensions of clinical pain and a lower experimentally induced pain threshold independently of both age and gender. No other psychopathological dimension predicted the increased perception of pain in patients with intractable pain. ConclusionsAs well as contributing to the body of knowledge on gender bias in pain, our results indicate that is not solely the source lesion that makes pain difficult to treat, but rather individual components of pain perception, including sociodemographic and somatisation features, whose influence should therefore be recognized and treated appropriately as routine.