Alexithymia’s Role in Chronic Pain

A variety of chronic pain conditions are linked with alexithymia, or difficulty identifying emotions in the self and others, a new review finds.

The review, published May 23 in the journal Current Rheumatology Reports, drew together studies that examined alexithymia or emotional processing in the context of chronic pain. While there were only a handful of studies per pain condition, the results generally found a high prevalence of alexithymia. The relationship between chronic pain and alexithymia was frequently moderated by depression or negative affect, though more work is needed to understand the connection, authors Marialaura Di Tella and Lorys Castelli of the University of Turin in Italy wrote.  [[{"type":"media","view_mode":"media_crop","fid":"49059","attributes":{"alt":"©Lightspring/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8760106242352","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5901","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©Lightspring/Shutterstock.com","typeof":"foaf:Image"}}]]

Alexithymia is seen in less than 10 percent of the population. In many cases, it is a stable personality trait. It can also develop in response to stress, and is often comorbid with psychiatric disorders such as post-traumatic stress disorder or major depression.

Castelli and Di Tella conducted a literature search and found 15 studies on alexithymia and chronic pain conditions, including general chronic pain (4 studies), temporomandibular disorders (3 studies), complex regional pain syndrome and low back pain (1 study), fibromyalgia (4 studies, including one that also included rheumatoid arthritis patients), migraine (1 study) and irritable bowel syndrome (2 studies).

By condition, these studies found:

-  In patients with general chronic pain, there is a higher prevalence of alexithymia than in the general population; patients with alexithymia and general chronic pain are often in more pain than those without alexithymia. Negative affect and depression usually mediate the link.

-  In patients with temporomandibular disorders, alexithymia is more common than in healthy controls. Patients with alexithymia and temporomandibular disorders are more likely than those without alexithymia to struggle with facial emotion recognition, have more psychological distress and more pain. 

-  In patients with complex regional pain syndrome, alexithymia is more common than in patients with low back pain. So is psychological distress. Pain was significantly associated with alexithymia in the complex regional pain syndrome patients but not in the low back pain patients.

-  Fibromyalgia patients also experience alexithymia at higher rates than healthy controls, and fibromyalgia patients with alexithymia report higher levels of pain than those without. The relationship is often mediated by depression and other psychological factors. A 2012 study compared patients with fibromyalgia and rheumatoid arthritis to healthy controls and found deficits in ability to describe one's own emotional condition.

-  Patients with chronic migraine are higher in depression, anxiety and alexithymia than healthy controls, and the ability to identify and describe feelings as separate from body sensations predicted pain frequency in the previous three months.

-  Irritable bowel syndrome is also associated with alexithymia, and alexithymia is a strong predictor of the severity of the disorder.

Alexithymia may prevent chronic pain patients from being able to seek help and comfort from others, the researchers wrote, which could in turn increased their levels of depression and anxiety. Or, the connection could be linked to the subjective experience of pain. Some data suggest that it's the affective, rather than sensory, experience of pain that best correlates with alexithymia. The issue is complicated by the fact that patients with alexithymia may have difficulty self-reporting the condition.

New research that uses multidimensional measurements of pain as well as performance-based measurements of emotional processing is needed to clarify the relationship of alexithymia to chronic pain, Castelli andDi Tella wrote.  

References:

Tella MD, Castelli L.

"Alexithymia in Chronic Pain Disorders." 

Curr Rheumatol Rep Current Rheumatology Reports

. 2016;18(7). doi:10.1007/s11926-016-0592-x Baeza-Velasco C, Carton S, Almohsen C, Blotman F, Gély-Nargeot MC.

"Alexithymia and emotional awareness in females with Painful Rheumatic Conditions."

Journal of Psychosomatic Research

. 2012;73(5):398-400. doi:10.1016/j.jpsychores.2012.08.008