Problems of psychogenic, reflected and phantom pain syndromes in somatic pathology in manual therapy
The pain is an unpleasant emotional and sensory experience, as well as stress reaction that mobilizes functional systems. Not only for protection. On the other hand it is an adaptive response to the impacts of a pathogenic factor. An important role in the etiopathogenesis of pain plays psychological factors, and especially mental processes. As a result of the systematic study of pain syndrome, many authors identify a separate clinical form of chronic pain - chronic "polysymptomatic hysteria" (Briquette’s syndrome), or a second type "somatoform pain disorders". They are identified with psychologies, psychogenic and psychosomatic. In recent years, the structure of pain has been undergoing a transformation. One of the first places in somatic diseases is filled by phantom, reflected, psychogenic pain. The pain in 90% of cases becomes chronic pathology. Chronic pain, against somatic diseases, often leads to the oppression of mental status and severing somatic pathology. Phantom, reflected and psychogenic pain are the same etiopathogenetic mechanisms. They are very difficult to treat, and often do not respond to treatment. Such pain occurs on the background of disorders of the central nervous system. Pathological algic system forms various pain symptoms and syndromes of both the central and peripheral nervous system with help of plastic processes. The pain is a relatively stable system carrying emotional color. Emotional color, emotional acting brings not only pain, but disease in general. At the same time the very emotional acting starts plastic processes of algic system forming a generator of pathologically enhanced excitation. So starts the pathological mechanism of endogenous process, forming a chronic pain syndrome, phantom, psychogenic and reflected pain. Formed endogenous process carrying emotional color, causes autonomic disorder of peripheral and central nervous system. Taken into account that origin of psychogenic, reflected and phantom pain is the same, but number of psychogenic pain is different, they are forming on the finished, but "dormant" pathological process, then this pain syndrome pathogenesis is more suitable term phantom pain.
So phantom pain occur against the background of disturbances of the central nervous system under the influence of a powerful stream of pulses that can overcome the inhibitory mechanisms of regulation and control, and cause pathological activity. A powerful stream of pulses produces a group of neurons located in the hyperactive phase and forming a generator of pathologically enhanced excitation (G.N. Kryzhanovsky). Because neurons of generator activate each other. The generator is able to maintain its activity, without the need for constant and additional stimulation from the outside. Thus, the generator becomes an endogenous mechanism for development of the pathological process. The nature and operation of generators formed in different parts of the central nervous system and in different conditions, varies. In this regard, various generators, or the same one at different stages of development forms various pathological systems underlying corresponding nerve disorders. Such pathological CNS systems actively affect others, involve them in pathological reaction and combine them into a new pathological organization. This pathological entity determines the department of CNS and gets the value of pathological determinant. Pathological determinant is the most resistant part of the pathological system . Pathological determinants are formed in the period of fetal development, during the formation of the so-called perinatal matrices.
Fetus feels the mother's attitude that surrounds him and his mother world .Thus formed pathological determinants are painted emotionally, but not edited emotionally and form a stable pathological system by cores of aggrieved affects (emotionally colored pathological determinant). So even in uterus conditions for algic pathological process of a disease, for pain generator of pain are laid. And its emotional color depends on the behavior and emotional mood of the mother. So happens triggering of pathological determinants in the process of giving birth and the first years of life. Against this background, any disease, any stress triggers one or another generator of pain, which, in turn, triggers a corresponding pathological emotive determinants, which generate stable somatic pathology, manifested phantom pain syndrome, or hereditary disorders accompanied by phantom pain syndrome.
During the suppression of pathological system or its liquidation determinant structure is preserved even when the other structures of system are already normalized and left its composition (determinant dies last) GN Kryzhanovsky . Emotive determinant is a persistent pathological structure and in liquidation of pathological system the determinant decays. But its emotional color remains intact, and freezes in the nucleus of brain and spinal cord (the subconscious) as the core of aggrieved affect, forming long-term memories of emotionally colored pathological determinant. The pain syndrome was stopped, there comes remission.
When restoring a pathological system under the influence of new pathogenic effects determinant structure activates before others (determinant resurrected first), G.N. Kryzhanovsky, which helps to restore a pathological system . The core of aggrieved affect is constantly seeking confirmation of the presence of any disease process to recover the corresponding emotive pathological determinants. Such restored pathological determinant forms a completely new pathological system, involving in pathological process new, yet untapped, structures and systems of the body. In consequence of that, on the basis of feedback, generators of pain start work, not only of restored emotive pathological determinants, but also form a new generator pain having entirely determined new disease process.
Stopped pain syndrome becomes the clinical expression of this process, as well as the pathological system that caused the disease with this stopped pain syndrome have been destroyed, it does not exist, then rebuilt pain syndrome does not bear the pathological mechanism. It is a phantom of the existing emotive pathological determinant. Others appeared again, pain symptoms and syndromes don’t have a clearly defined pathology i.e. provoked by core of aggrieved affect emotive pathological determinants. And running pain generators has not yet formed a new pathological system. They are the phantom of the future pathological process.
Pathological system underlies various nervous disorders related to various areas of nervous system, so their structures are virtually universal value pathogenetic mechanism. Securing a pathological system leads to chronization of disease process and related pathological disorders. Due to the inhibition of other systems operating at the moment system is not experiencing the influence from other systems. It provides the programmed result without distortion.
Better to say, there is a dominance of the pathological systems over physiological one that forms in the central nervous system a dominant of pathological determinants, or call it pathological dominant. The structure, fulfill the role of emotive pathological determinant in relation to this system can serve as dominant in relation to the other structures of the physiological system, stifling her activity.
Violation of the dominant relations can take place in various forms of diseases of nervous system; they are a typical pathological process, carried out at the level of system relations.
Violation of dominant relationship expressed either in the form of failure, either in the form of their excessive amplification. In different cases, a persistent pathology occurs. During excessive strengthening of dominant relationship pathology is that physiological systems and other CNS structures are experiencing inadequate strong braking, combined with the activity of the nervous system. Hyperactive pathological value system acquires pathological dominant: it causes inhibition of physiological systems and in connection with this disruption of the CNS. The combined implementation of the principles and the dominant determinants is essential for the physiological activity of the system and achieve its desired result. Violation of this combined implementation of these principles is pathology and one of the endogenous mechanisms of nervous disorders.
Chronic pain syndrome, endogenous masked depression, neuroses, emotional affective disorders, V.S.D., psychogenic pain, neuroses, psychogenic, chronic pathological process in organs and body systems as well as phantom pain. So when involved in a pathological system of target organs pathological changes occur in them, involving in the process autoimmune mechanisms, endocrine systems, changes at the molecular level and the genetic apparatus, involving in pathological process not only the central and peripheral, and autonomic nervous system. It is pertinent to mention regulation diseases and in particular diseases of the nervous system regulation. Any authority, any system, becoming the target of a physiological or pathological process becomes a hostage of deregulatory pathology. There are no organic changes, but the disease exists.
Disorders of the nervous regulation may be due to changes, both in the central and peripheral links regulation unit. In both cases, these links are pathological determinants; cause the appearance of pathological systems, peripheral efferent part of which is the target organ. The clinical expression of the activity of these substations is relevant syndromes. If inner organs are the target organs then occurs neurovisceral pathology takes place. If autonomic centers become pathological determinant arising syndromes are centrogenic autonomic disorders.
Any disease, even the short, launches phantom pain, and all of the above physiological and pathological dominants and determinants, pain generators, broken system relations. These processes induce an altered state of consciousness. Emotional distress, fear of pain, fear of death, cause narrowing of consciousness, make the patient more inadequately perceive the disease, condition. There is a pathological change of consciousness. During treatment, medicaments are prescribed which in one way or another affect the central nervous system, autonomic and peripheral nervous system, the biochemical processes. This reduces the threshold of pain perception, slowing down the momentum of nociceptive fibers; autonomic nervous system partially (substitute work) of the peripheral nervous system, there is a recoding of pain generators. So the treatment itself generates its own emotionally charged pathological determinant and pathological dominant, which supports the pathologically altered consciousness indefinitely, launching a new phantom pain and stimulates existing one. The more intensity and duration of the treatment, the more intensive pathological system works, the more intensive the conflict between dominant and system relations, more various symptoms and syndromes that replace each other, without leading to a stable improvement of health, and especially to his recovery. Taking into account initially accentuation of character and pathologically altered state of consciousness, the duration of treatment, mental changes, impaired behavioral stereotypes, in one way or another chronic disinhibited isteroid with chronic polysystemic diseases forms.
These patients are more likely to seek medical care, placing a lot of complaints about their health. They are treated and consulted by different specialists. They do not trust their doctor; treat themselves, without informing the doctor of taking the drug. They complain of the pain of varying intensity and localization, of physician, improperly prescribed treatment, extort attention of doctor and devalue his work. Such patients are referred to a psychiatrist for treatment and often treated as a neurotic or isteroids. And most interesting is that doctors begin to treat the phantom pain syndrome, but not a disease, not a patient. Neurological patients and somatic ones deny psychological factor of their illness. The majorities of patients do not take into account and do not associate stress, emotions, mood, emotional state, and the state of mind with their illness. But doctors often do not betray the attention of the mental processes of the disease. A vicious circle, somatic effect on the psyche, mental processes aggravate and exacerbate somatic pathology. The management and treatment of these patients is necessary and even more necessary involvement of psyhosomatologist. Psychosomatics sufficiently developed in the direction of psychotherapy, but has not yet gained popularity in public health and clinical medicine and slowly put into practice . Many experts underestimate psychotherapy, bringing methods and techniques of psychosomatic medicine to the commonplace prescription of antidepressants and other psychotropic medications. Psychotherapy certainly helps the doctor in treating the patient and the patient in his illness.
Psychosomatic methods reduce the drug load on a patient, re-formed the dominant recovery, support the emotional and mental health of the patient. It is important to assess the emotional color of the disease and the emotional experience of the disease. Memories of pain are reduced by the core of aggrieved affect of long-term memory, emotionally colored pathological determinant. Therefore it is necessary to pay attention to patient's emotional status, to teach him not to be afraid of the disease and live with positive attitude, thereby denying her pathological determinant of emotional color "determinant will never revive."
One of the methods of psychotherapy that can solve the problems of health, emotional state of the patient is the music therapy. Music therapy simultaneously affects both the psychic and somatic processes, balances emotionally, prioritize in dominant and determinant relations. It breaks the vicious cycle of pathological effects of mental and somatic pathology. As a basis we took the music program of Dedinskaya E.P. It consists of four disks. Patent №2150301 "Method of improvement of health through a constructive way out of stress."
"Echoes of Silence" - the key to the code of ego state. It levelers anxiety, fear and panic, creates a safe environment for patients in the treatment of generalized anxiety disorder. It is irreplaceable in the treatment of phobic disorders and panic attacks; reduces muscle tension. It restores natural motor and behavioral stereotypes. It has a stabilizing effect on the central nervous system. Removes overcontrol and gives a deep, natural, relaxing effect. It promotes oppression and stops the work of pain generators, relieves emotional stress emotive pathological determinants. Gradually stops phantom pain. It restores the system relations.
"The Way of the World" is a restoration of relations between the unconscious and consciousness. Activity of the brain in the perception of the world increases, contributes to the restoration of adaptive mechanisms of the central nervous system. It participates in the correct formation of the dominant and determinant interactions and normalization of relations and recognition of systemic differences between objects and images. It creates a more orderly and efficient active environment for the dominant recovery, stimulates it. There is the restoration of the passage of nerve impulse through conduction paths. Link is reconstructing - inverse relationship between the central nervous system and organs and systems of the body; promotes removal of blocks. Increases not only doctor’s empathy, but also the patient’s.
It helps patient to understand himself. Promotes discharged of «the core of aggrieved affect» the proper goal setting and social adaptation of the patient in the world. It breaks off pathological interaction between: a generator phantom pain of its emotive pathological determinant and its pathological dominant.
"My life, my love" restores a person emotional and psychological component. It aligns the excess and lack of emotion, helps stabilize the body emotionally; helps to build a bridge between the feelings, emotions and the world in which the patient has to come back. It allows the patient to regain control over him, to dive into the experience, emotional support consciousness for a long time. Stimulates the patient to be happy when it is merrily, to be sad, when it is sad, without allowing emotions to destroy their mental and physical health, without falling into the border states, and psychotic disorders. Find their way to the deepest areas of our psyche even through emotional pain. It gives a sense of inner support. It helps to bear with emotional color of pathological determinants. Emotionally respond perinatal matrix.
"Dr. Dream for children and adults" helps to get to the deepest archetypal material. Founded on the principle of vibration underlying "maternal lullaby," allows a person to return to the purity and openness of childhood, restores psychological protection. It gives a sense of stability, security and eternity. It includes all the sounds of nature, which allows the patient to return to natural interaction with the outside world, as well as to remove the emotional damage associated with prenatal and postnatal period. It is used for depressive disorders of varying severity. Pulls the patient out of depression without traumatic experiences, gives lasting effect. It allows the physician more thoroughly and efficiently carry out sessions of psychoanalysis. Enshrines the effect of the session listening patient drive yourself home. Normalizes sleep, improves the health. It has a favorable effect on women during pregnancy and childbirth. Promotes normalization of contact "mother-child".
The sample of 96 patients with chronic pain, including reflected and psychogenic. The share of women is 89.6%, the average age of 52.0 ± 1.0 years. The proportion of men was 10.4%, an average age of 46.0 ± 1.0 years. The proportion of patients with headache was 49%, the proportion of patients with psychogenic and reflected pain was 49%.
The proportion of patients with pain in the legs, hip and knee joints was 75% and 4%, respectively, the proportion of patients with psychogenic and reflected pain was 50.6% and 33.3%, respectively. The proportion of patients with low back pain and lower back was 87.5% , men 79.1% and women 8.4%, the proportion of patients suffering from psychogenic and reflected pain was 77%, men 42 34.2% and women 8%. The duration of pain was 15.5 ± 0.5 years.
The clinical laboratory examination: radiography, COMPUTER tomography, Doppler, psychological testing, manual diagnosis, clinical and biochemical blood tests. Viewed doctors: therapist, neurologist, psychologist and psychotherapist, chiropractor.
Treatment: manual therapy: manual diagnosis, traction, manipulation, mobilization, post isometric muscle relaxation, craniosacral therapy, myofascial release therapy: music therapy and psychotherapy explanatory. Music therapy was performed on admission and independently at home, according to the scheme assigned by chiropractor.
According to the results of treatment in patients with pain was fully stopped and 39.6% had a stable remission. The proportion of patients reported improvement of health was 31.25%. Pain syndrome has become less intense and less prolonged. Patients received retreatment after 3 and 6 months, respectively, it was 31.2% of patients. The remaining patients (29.2%) during treatment noted improvement, but at the end of therapy began to show earlier complaints. They were re-examined by a neurologist and psychotherapist. Coarse organic pathology was not found. There was improvement of physical and mental health. The recommendations about changing behavior pattern and termination of manipulation health were given, to undergo psychotherapy. During the year, there were no patients with complaints of pain and symptom of degradation.
As a result of the treatment it was found that phantom pain syndrome (psychogenic and reflected) is more than 30% of cases. In some nosologies it was 50% of cases. Application of music therapy during treatment (including application at home) was very effective and allowed 40% of patients achieve sustained remission. Joint management of patients with psychotherapist and psyhosomatologist allowed more accurate to diagnosis, identify patients manipulating health that almost amounted to 30% of pathology. Timely and qualified administration of medical aid to such patients. Timely protect chiropractor and other doctors from unreasonable complaints, specifically pay attention and competently prescribe treatment of mental component of illness.
Music therapy is simple, effective and aseptic method of psychotherapy. It is simple to use, and can be carried out during the reception and treatment of patients and on their own at home under the scheme. During treatment there were no paradoxical and affective reactions in patients and physicians, there was no getting used to this music program, and depending on it. In addition, music therapy solves the problem of empathy and physician’s burnout in the workplace.
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Moscow, Russia 2015