Psychopathological context of alexithymia in patients with back pain

Czech version

Authors: Z. Hermanová ¹; P. Vesel; Ganoczyová ¹; M. Chýlová ²
Authors‘ workplace: 1. psychiatrická klinika, Univerzitná nemocnica L. Pasteura, Košice, Slovensko ¹; 1. psychiatrická klinika LF UPJŠ a Univerzitná nemocnica L. Pasteura, Košice, Slovensko ²
Published in: Cesk Slov Neurol N 2023; 86(1): 57-62
Category: Original Paper
doi: https://doi.org/10.48095/cccsnn202357

Overview

Aim: Back pain represents one of the main symptoms of research in psychosomatic medicine. This cross-sectional study follows alexithymia as a personality trait leading to somatization, worsened pain, and negative affectivity in patients with back pain. Materials and methods: Ninety-eight responders participated in the study. The clinical sample included 47 patients, aged 24–81 years, diagnosed with back pain, and there were 17 males (36.2%) and 30 females (63.8%). Healthy sample consisted of 51 responders without back pain including 20 males (39.2%) and 31 females (60.8%) aged 20–71 years. The Toronto Alexithymia Scale (TAS-20) was applied to measure alexithymia. Psychopathological variables including somatization, depression, and anxiety were determined by the Symptom Check List (SCL-90), and pain intensity by using the Visual Analogue Scale. Nonparametric tests of correlation and difference statistics were applied to analyze data. Results: The outcomes confirmed a significantly higher prevalence of alexithymia in the clinical sample compared to healthy responders (z = –2.138; P ≤ 0.03). The presence of alexithymia in patients was related to higher rates of somatization, depression, anxiety, and pain. Pain intensity was most significantly associated with somatization and depression. Patients differed significantly in the level of alexithymia, anxiety and depression, females achieved a higher score in alexithymia compared to males (z = –2.002; P ≤ 0.045), and chronic pain patients in comparison to acute ones (z = –2.34; P ≤ 0.02). Conclusion: The findings suggest important links between alexithymia, psychopathological variables, and pain experience in patients suffering from back pain. This should be taken into account in the complex management treatment of back pain in neurology and psychiatry.

Keywords:

back pain – Pain – alexithymia – psychopathology

Sources

1. Martuliak I. Možnosti liečby bolesti chrbta – 1. časť. Via Prac 2009; 6 (2): 79–84.

2. Sekot M. Medicínsky nevysvětlitelné symptomy – diagnostika a léčba. Int Med 2013; 15 (3–4): 121–124.

3. Lumley MA, Schubiner H. Psychological therapy for centralized pain: an integrative assessment and treatment model. Psychosom Med 2019; 81 (2): 114–124. doi: 10.1097/PSY.0000000000000654.

4. Americká psychiatrická asociácia. Príručka k diagnos- tickým kritériám DSM-5. Bratislava: Vydavateľstvo F 2018.

5. Národné centrum zdravotníckych informácií NCZI. Medzinárodná klasifikácia chorôb MKCH-10. [online]. Dostupné z: https: //www.nczisk.sk/Standardy-v-zdravotnictve/Pages/Medzinarodna-klasifikacia-chorob-MKCH-10.aspx.

6. Manfré L, Van Goethem J. Low back pain. In: Hodler J, Kubik-Huch RA, von Schulthess GK (eds.). Diseases of the brain, head and neck, spine 2020–2023: diagnostic imaging. Cham, Switzerland: Springer 2020; 225–231. doi 10.1007/978-3-030-38490-6.

7. Chromý K. Alexitymie – vývoj a současný význam konceptu. Čes Slov Psychiat 2006; 102 (7): 363–370.

8. Uhrová ED. Psychosomatika. In: Heretik A, Heretik A Jr. (eds.) Klinická psychológia. Nové Zámky: Psychoprof 2007: 481–483.

9. Lane RD, Weihs KL, Herring A et al. Affective agnosia: expansion of the alexithymia construct and a new opportunity to integrate and extend Freud‘s legacy. Neuro Biobehav Rev 2015; 55: 594–611. doi: 10.1016/ j.neubiorev.2015.06.007.

10. Linton SJ, Flink IK, Vlaeyen JWS. Understanding the etiology of chronic pain from a psychological perspective. Phys Ther 2018; 98 (5): 315–324. doi: 10.1093/ptj/pzy027.

11. Lumley MA, Stettner L, Wehmer F. How are alexithymia and physical illness linked? A review and critique of pathways. J Psychosom Res 1996; 41 (6): 505–518. doi: 10.1016/s0022-3999 (96) 00222-x.

12. Katz J, Melzack R. The McGill pain questionnaire: development, psychometric properties, and usefulness of the long form, short form, and short form-2. [online]. Dostupné z: https: //core.ac.uk/download/ pdf/10988388.pdf.

13. Bagby RM, Parker JD, Taylor GJ. The twenty-item Toronto Alexithymia Scale – I. Item selection and cross-validation of the factor structure. J Psychosom Res 1994; 38 (1): 23–32. doi: 10.1016/0022-3999 (94) 90 005-1.

14. Hošková-Mayerová Š, Mokrá T. Alexithymia among students of different disciplines. Proc Soc Behav Sci 2010; 9: 33–37. doi: 10.1016/j.sbspro.2010.12.111.

15. Látalová L, Pilárik Ľ. Overenie reliability a faktorovej validity slovenskej verzie dotazníka Toronto alexithymia scale-20 (TAS-20) na súbore slovenských študentiek. Čes Slov Psychol 2015; 59 (4): 369–379.

16. Bieščad M, Szeliga P. Skúsenosti s použitím sebaposudzovacej škály (SCL-90) na výberoch slovenských psychiatrických pacientov a bežnej populácie. Psychiatria 2006; 13 (1–2): 25–31.

17. Yeung AWK, Wong NSM. The historical roots of visual analog scale in psychology as revealed by reference publication year spectroscopy. Front Hum Neurosci 2019; 13: 86. doi: 10.3389/fnhum.2019.00086.

18. Acklin MW, Alexander G. Alexithymia and somatization. A Rorschach study of four psychosomatic groups. J Nerv Ment Dis 1988; 176 (6): 343–350. doi: 10.1097/ 00005053-198806000-00003.

19. Adilay HU, Guclu B, Goksel M et al. The correlation of SCL-90-R anxiety, depression, somatization subscale scores with chronic low back pain. Turk Neurosurg 2018; 28 (3): 434–438. doi: 10.5137/1019-5149.JTN.19318-16.2.

20. Mattila AK, Salminen JK, Nummi T et al. Age is strongly associated with alexithymia in the general population. J Psychosom Res 2006; 61 (5): 629–635. doi: 10.1016/j.jpsychores.2006.04.013.

21. Hoy D, Brooks P, Blyth F et al. The epidemiology of low back pain. Best Pract Clin Rheumatol 2010; 24 (6): 769–781. doi: 10.1016/j.berh.2010.10.002.

22. Di Tella M, Castelli L. Alexithymia in chronic pain disorders. Curr Rheum Rep 2016; 18 (7): 41–50. doi: 10.1007/s11926-016-0592-x.

23. Fresán A, Gonzáles-Castro TB, Pool-García S et al. Evaluation of alexithymia in individuals with chronic pain in a Mexican population: alexithymia in a Mexican population. Int J Psych Med 2021; 56 (3): 177–188. doi: 10.1177/0091217420982086.

24. Bykovskiy PV, Sherman MA. Effectiveness of neurofeedback therapy for acute nonspecific vertebrogenic pain in individuals with an increased level of anxiety. Saratov J Med Sci Res 2020; 16 (1): 333–336.

25. Mirsharifa SM, Mirzaian B, Dousti Y. The efficacy of Acceptance and Commitment Therapy (ACT) matrix on depression and psychological capital of the patients with irritable bowel syndrome. Open Access Maced J Med Sci 2019; 7 (3): 421–427. doi: 10.3889/oamjms.2019.076.

26. Burger AJ, Lumley MA, Carty JN et al. The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: a preliminary, uncontrolled trial. J Psychosom Res 2016; 81: 1–8. doi: 10.1016/j.jpsychores.2015.12.003.