Doctors May Do Better With Clearer Understanding of Somatisation

Posted November 5th, 2009 by Matt

Pain Management

Somatisation (also spelled somatization) is the process of a mental or emotional feeling or stress becoming a physical feeling. Researchers often wonder about somatisation and psychosomatic behavior because it's a puzzling part of the human body and mind. Not only is it puzzling, it's very common. Many people experience somatisation at some point, with fatigue and nausea for example.

Many times, a patient sees a doctor for a problem, such as pain or nausea, but for which a cause can't be identified. It is then not unusual for the doctor to refer to the problem as idiopathic, or of unknown origin. However, it is possible that some of these are somatic, not physical and then the problem may be labeled as somatic. However, by labeling the pain, is the patient getting the proper type of treatment? To look into this more, the researchers of this article wanted to review if studies have been done on somatisation and its relationship to pain, and how effective the studies were.

The researchers searched through the medical literature and found 116 studies that fit their requirements. This meant the studies were in English, were published in 1989 or later, had at least 20 study participants who were adults, had independent measurements of somatisation and pain, and investigated the relationship between somatisation and pain.

What the researchers found was that the primary purpose of the studies did not often even include somatisation. In fact, the majority of the studies did not define the word. The researchers also found that when the authors of the studies looked at somatisation, they were only looking at multiple (more than one) physical complaints. And finally, the studies did not report if people who had somatic complaints received help for them. There were no clear cut outlines to define or measure a somatic complaint.

In order to measure somatisation, most of the studies relied on the subjects filling out a questionnaire, most often the Symptom Checklist or the Brief Symptom Inventory. Only five studies used a structured interview to find out if the subjects had somatisation. Very few studies followed up to see if something physical could be causing the subjects' pain and only one study of all 116 asked if the subjects were getting help for their symptoms. The authors of this study also wrote, "None of the studies reported of having addressed the last criterion of somatisation, namely whether people attribute the complaint to a physical cause."

The authors concluded that using the terms somatisation leads to misuse in many cases due to a lack of research and understanding. According to the authors, using the term somatisation could, unknowingly, lead doctors into treating patients only with the somatisation in mind, without investigating further into the physical issues that could be contributing to pain.

Geert Crombez, et al. The unbearable lightness of somatisation: A systematic review of the concept of somatisation in empirical studies of pain. In Pain. September 2009. Vol. 145. Nos. 1-2. Pp. 31 to 35.

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