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SOMATOFORM PAIN DISORDER
Somatoform pain disorder is pain that has been observed in one part or all of the body for at least six months or longer. The current pain cannot be adequately explained on the basis of physical disorders. Somatoform pain disorder usually begins with acute, physically caused complaints, but these complaints decrease over time and cannot be the cause of the pain that still exists. The pain continues without a physical cause.
In addition to the pain in the body in some patients, there is a feeling of pain and pressure in the heart area, frequent sweating, fatigue quickly, swallowing problems, shortness of breath (inability to get enough fresh air), tingling and numbness in the arms, hands, etc. symptoms may appear.
The reasons why pain persists or occurs without a physically identifiable cause lie in psychology. Many of those affected have been unable or have inadequately resolved their emotional conflicts, which have often been simmering for many years. Dissatisfaction with a partner or job, bullying, constant stress, emotional injuries, excessive demands and emotional trauma can be the causes of this condition. Mostly, people who are in the middle of life, who are very productive, well organized and often responsible are affected. However, it can also affect people who have had emotional problems such as depressed mood for years.
Patients with somatoform disorders represent the largest group of patients in many doctors’ offices and general hospitals. Its symptoms appear individually or simultaneously, and they disrupt the patient’s health for many years, but there are no organic signs. According to current information, successful treatment can only be achieved in an interdisciplinary way, but in practice this is still very far away.
Patients with somatoform disorders often have unrealistic assumptions about physiological relationships and bodily functions. Harmless dysfunctions, minor illnesses, somatic side effects of intense emotions, even normal physiological processes are misinterpreted and perceived as symptoms of serious illness. Even the smallest irregularities trigger fear and panic. Patients observe their body functions intensely and anxiously and feel the need to reassure themselves with the Turkish doctor and their relatives about the harmlessness of the symptoms. They believe that they are weak, fragile and sensitive and need special care.
In addition, these patients are firmly convinced of a physical cause of their symptoms and often need diagnostic and therapeutic invasive interventions. In response to pressure from the patient, doctors often prescribe agents whose relationship to symptoms is unclear, such as sedatives, neuroleptics and painkillers, which, with long-term use, can lead to damage and addiction as a result. If these do not provide the hoped-for relief, patients doubt the competence of the doctor and look for someone else. Their attitudes, feelings and behaviors also change. Those affected feel fear, anxiety and sadness in their situation on the one hand, and irritability and anger on the other. They react with frequent doctor visits and uncontrolled self-medication. They avoid exertion, social contacts and leisure activities.
The causes of somatoform disorders are also largely due to psychological factors. Neglect in childhood, the loss of important caregivers, sexual abuse and difficult living conditions, as well as traumatic experiences in adulthood can cause this condition. Since somatoform disorders are multifaceted and diverse, the first obstacle that needs to be overcome is the correct diagnosis. What makes the diagnosis difficult is that somatoform disorders have many overlapping features of depression, anxiety and psychosomatic complaints. Somatoform disorders occur with psychological disorders such as post-traumatic stress disorder.
A second obstacle is the patient’s organic disease model. They believe that the cause of their problems is due to physical problems (spinal problems etc). Although such models are often based on false assumptions, patients fervently defend them. The third obstacle arises from the patient’s coping behavior. After years of unsuccessful treatment attempts, patients have adopted behaviors that have proven themselves in coping with symptoms, such as restraint, avoidance behavior, and frequent doctor changes.
Because somatoform disorders are very stable and are neither easy to diagnose nor treat, many specialists set treatment goals very low. Even a slight decrease in symptoms, pain and visits to the doctor in Turkey is considered a success. However, the complete elimination of complaints is almost impossible to achieve even with professional treatment. Therefore, the treatment goal should be to increase the tolerability of symptoms in order to make painful life more bearable.
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