The unbearable lightness of somatisation: A systematic review of the concept of somatisation in empirical studies of pain

Abstract

Somatisation is often invoked to explain pain and suffering in patients. Lipowski [34] defined somatisation as "a tendency to experience and communicate somatic distress and symptoms unaccounted for by pathological findings, to attribute them to physical illness, and to seek medical help for them" (p. 1359). His concept is widely accepted. This study investigated to what extent this conceptualisation is used in the empirical studies of pain. Studies were identified through searches from Web of Science, Pubmed and Psychinfo databases for the period from 1989 until 2007. Screening an initial set of 1020 articles resulted in 120 articles fulfilling inclusion criteria. One hundred and sixteen articles were retrieved and coded in terms of the conceptualisation of Lipowski [34]. All studies had a measure of somatic symptoms, most often questionnaires. Whether the symptoms were unaccounted for by pathological findings was rarely investigated. No study assessed whether the participants attributed the somatic complaints to physical illness. Most studies included patients seeking help in a clinical setting, but only one study investigated whether patients were seeking help for the somatisation complaints. In conclusion, no study fulfilled the construct criteria as defined by Lipowski [34]. Most studies focus upon the extent and diversity of somatic complaints. We recommend that researchers who use self-report instruments do not use the term "somatisation" (even if the instrument is labeled as a "somatisation" scale), but use the term "multiple physical symptoms" instead. The current operational use may unduly lead to a "psychologisation" of physical complaints.

Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

“…The DSM-IV criteria for somatoform disorders have shortcomings 48 and may be replaced by a category of "somatic symptom disorders"; 49 the proposed new diagnostic criteria may better distinguish individuals with and without a history of FAP.…”

Persistent pain: not a medically unexplained symptom

“…4 Again, almost regardless of origin or site of pain, imaging of brain processing and behavioural studies show consistent changes, 5 leading to serious suggestions that persistent pain may be considered a disease in its own right. 5 Despite these consistent evidence-based explanations, reports of pain which are judged not to correspond to physical signs have long been classified as a 'somatisation' phenomenon (a recent review 6 exposes the poor scientific basis of this), and more recently as medically unexplained. Pain is very heavily represented in any of the varied lists of MUS.…”

Anxiety is Prevailing in Non-Cardiac Chest Pain Subjects, while Somatisation is Not A Comparative Study in the Emergency Department

“…When considering the somatisation approach, we may refer to the systematic review carried out by Crombez et al [5], which analysed the concept of somatisation in empirical studies of pain. This review was able to identify 116 studies, most of which used the SCL-90 scale.…”

“…The somatisation construct seems less useful to distinguish NCCP from CCP subjects. Consequently, anxiety should be the major target of our mental-health intervention when treating subjects with chest pain.Citation: Balestrieri M, Isola M, Gangi F, Sbrojavacca R, PResT-ED (2016) When considering the somatisation approach, we may refer to the systematic review carried out by Crombez et al [5], which analysed the concept of somatisation in empirical studies of pain. This review was able to identify 116 studies, most of which used the SCL-90 scale.…”