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Pain asymbolia: characteristics, symptoms and causes

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We have all experienced physical pain to a greater or lesser degree. However, some people have lost this ability, or have it altered.

We are going to delve into the subject of the asymbolia of pain to see the implications of this pathology and what are the causes that may be causing this dysfunction in the perception of pain as we know it.

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What is the asymbolia of pain

The asymbolia of pain, also known by the medical term of analgognosia, refers to an inappropriate reaction to a painful stimulus, due to difficulties in identifying it. Some of these reactions may be not removing the part of the body that is suffering damage from the aversive stimulus (not removing the hand of fire, for example), not expressing a gesture of pain on the face, or not showing a psychological reaction to the element harmful.

The expression asymbolic pain was coined by Paul Schilder and Erwin Stengel., neurologists, psychiatrists and also psychoanalysts, based on a study carried out in 1927. In fact, in some manuals it is possible to find the Schilder-Stengel syndrome to refer to the asymbolia of pain, because as a result of said publication their own names were also used as nomenclature for this new pathology discovered.

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The case that these researchers studied was that of a woman affected by sensory-type aphasia that she repeatedly harmed herself, without showing any reaction to the pain that she should be feeling in the face of tremendous aggressions to her body. Tests were made with electrical stimulation, each time of greater intensity, and only in the highest ranks did they obtain a facial response to the aversive stimulus, but she at no time did she try to get away from the devices.

symbol of danger

The symbolism of pain It does not refer only to the fact of experiencing a sensation of pain, but also to the search for it.. Somehow, it would seem that the person suffering from this anomaly would try by all means to try to feel the damage, incredible as it may seem. For this reason, he would carry out increasingly intense self-aggressions, in an escalation to recover that disappeared sensation, however unpleasant it might be.

And it is that, Although the subject perceives the stimulus that is hurting him, his body is disconnected from the painful response that should be given., so that the stimulus loses the aversive component (only at the response level, since it continues to be harmful) and consequently the individual tends to experiment more and more, attracted by the performance of harmful behaviors, which do not cause pain some.

The big problem with this issue is that, even though the patient has lost the ability to feel pain, the injuries that are being self-inflicted are real, so You can experience serious consequences at an organic level, depending on how intense these behaviors have been. That is why sometimes the concept of asymbolia for danger is also discussed, since they are not aware of the damage that they are generating for themselves in their search for the sensation of pain.

Causes

But, what is the origin of the asymbolia of pain? This pathology seems to come from organic lesions in the brain, specifically in the parietal lobe left or in both hemispheres at the same time, and more specifically in the supramarginal gyrus, affecting the insula or insular cortex, in the Silvio fissure. The injury could come from a cranioencephalic trauma or through some internal pathology that was affecting said area.

It is considered that the specific area that would be directly involved with the asymbolia of pain would be number 43 in the list of Brodmann areas. When suffering a lesion in this region of the cerebral cortex, the connections between the sensory system and the limbic system would be being eliminated, which would explain why patients affected by this pathology do not have the physical capacity to relate the aversive stimulus to the painful reaction to it, since they are not capable of process it.

Depending on the severity of the injury, it is possible to suffer partial or total pain asymbolia, depending on whether the aforementioned connections have been destroyed. completely or instead there are still some active neural circuits that are capable of transmitting, even in part, the information related to the perception of pain in the receptors of the body and thus translate it into a consequent reaction, which will normally be much less than it should, by perceiving only part of the intensity of the stimulus.

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Comorbidity

The asymbolia of pain also has the peculiarity that it It can be linked to other pathologies of a different nature., how can they be Wernicke's aphasia (difficulties in understanding language), conduction aphasia (problems repeating words), apraxia constructive (loss of the ability to perform movement patterns to build elements or to draw).

They are not the only disorders that can occur as associated morbidity of asymbolic pain.. Others would be ideomotor apraxia (problems carrying out movements devised in the mind), autotopagnosia (difficulty perceiving the determined position of a part of one's own body) or aprosody (impaired ability to correctly perform or interpret the sound characteristics of language, that is, the prosody).

It is not surprising that there are a variety of neurological disorders that can appear in the patient at the same time as the pain asymbolia, since It must not be forgotten that these pathologies are caused by a brain lesion, so it is not strange that the same lesion affects different areas of the brain which, even when they are contiguous, have very different functions and can therefore trigger symptoms as varied as we have seen.

Other pain disorders

But asymbolia is not the only disorder related to pain. There are others with very peculiar characteristics. For example, we find analgotymia, a pathology in which the patient feels the pain caused by an aversive stimulus, he is able to identify and locate him without any problem, and yet he is absolutely indifferent on an affective level. Both disorders would share a lack of response to pain, but in the second case the sensation is experienced.

Another quite popular disorder due to its symptoms is PLP, or phantom limb pain.. This ailment manifests itself in some people who have suffered an amputation of one of their members, either an arm or a leg, and yet they suffer a recurring pain in that part of the body, which is no longer present. It may seem that this pathology is beyond logic, but the patient experiences a real sensation and therefore needs a treatment to alleviate it.

In fact, one of the techniques used to alleviate the pain of PLP is that of mirrors, in which, visualizing the healthy member in front of a mirror, try to focus the pain sensations of the member ghost. Some studies show that this technique helps to calm these sensations, causing an improvement in the PLP patient.

the opposite case

And, at the other end of the asymbolia of pain, we would find a disorder as common in our society as fibromyalgia, a disease that causes hypersensitivity to pain, without an apparent specific cause and that can also spread to different areas of the body, being able to cover a large part of it. The big problem with fibromyalgia is that it is a very broad disorder, which affects each person differently and therefore it is difficult to generalize an effective treatment.

Also in disorders opposed to the asymbolia of pain we can find the pathology known as hyperalgesia. This disease would be caused by damage to the nervous system and would cause the subject to experience a abnormally elevated sensation of pain in relation to the aggression of the harmful stimulus that is causing it triggering.

Finally, Another pathology associated with pain but which is also at the opposite pole with respect to the asymbolia of pain, would be allodynia.. It would also imply an excessive perception of the painful sensation, but in this case it would not be caused by a stimulus aversive, but by a stimulus that in principle should be neutral, such as tactile pressure and even a simple caress in some cases.

In addition, allodynia is not only associated with stimuli generated by skin pressure, but can also be caused by thermal sensations, such as so that contact with a substance at pleasant temperatures could also trigger in the subject a perception of immense pain, as if the stimulus was at a very low or very high temperature, when in fact it would be at room temperature, so it should not cause pain some.

Bibliographic references:

  • Gil, R. (2003). Neuropsychology. Barcelona. Elsevier.
  • Kim, S.Y., Kim, Y.Y. (2012). Mirror therapy for phantom limb pain. The Korean journal of pain.
  • Piulachs, P., Vara, R. (1974). The Sense of Pain. Institute of Spain. Royal National Academy of Medicine.
  • Schilder, P., Stengel, E. (1931). Asymbolia for pain. Archives of Neurology & Psychiatry.
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