Abstract
Persistent pain is not a normal part of aging. Nevertheless, many older patients have long-lasting, more or less medically unexplained pain symptoms and, consequently, are often severely disabled, incur high health care costs, and have high comorbidity rates. Moreover, the effects of early traumatization, especially due to wars, and even below the level of posttraumatic stress disorder (PTSD) are apparent. However, the developmental and neurobiological underpinnings of somatoform pain disorder, especially in pain-prone elderly patients, and its correlations with a history of war traumatization even decades after the incident remain unclear. Furthermore, a management strategy for this disorder tailored to older people and their special needs is lacking. Adequate therapeutic regimens such as adjusted psychotherapeutic procedures for elderly patients can only be promoted through a better understanding of the neurobiological and biographical underpinnings of this still controversial disorder.
Zusammenfassung
Anhaltende Schmerzen sind kein normaler Bestandteil des Alterns. Dennoch haben viele ältere Patienten dauerhaft eine mehr oder weniger medizinisch nicht erklärbare Schmerzsymptomatik. Sie sind damit oft schwer beeinträchtigt, verursachen hohe Kosten im Gesundheitswesen und zeigen eine hohe Komorbiditätsrate. Auch sind die Folgen früher Traumatisierungen, insbesondere durch Kriege und sogar unterhalb der Ausprägung einer posttraumatischen Belastungsstörung (PTSD), offensichtlich. Jedoch bleiben die Entstehungs- und neurobiologischen Grundlagen der somatoformen Schmerzstörung, vor allem in schmerzgeneigten, älteren Patienten, und ihre Zusammenhänge mit einer Vorgeschichte von Kriegstraumatisierung – sogar Jahrzehnte nach dem Ereignis – unklar. Darüber hinaus fehlt für diese Erkrankung eine Behandlungsstrategie, die auf ältere Menschen und ihre besonderen Bedürfnisse zugeschnitten wäre. Adäquates therapeutisches Vorgehen, wie angepasste psychotherapeutische Prozeduren für ältere Patienten, können nur durch ein besseres Verständnis der neurobiologischen und biographischen Grundlagen dieser nach wie vor kontroversen Störung gefördert werden.
Similar content being viewed by others
References
Afari N, Harder LH, Madra NJ et al (2009) PTSD, combat injury, and headache in Veterans returning from Iraq/Afghanistan. Headache 49:1267–1276
Aggarwal VR, Mcbeth J, Zakrzewska JM et al (2006) The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol 35:468–476
Arnold IA, Speckens AE, Van Hemert AM (2004) Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care. J Psychosom Res 57:517–520
Barsky AJ, Orav EJ, Bates DW (2005) Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry 62:903–910
Bower P, Rowland N (2006) Effectiveness and cost effectiveness of counselling in primary care. Cochrane Database Syst Rev 3:CD001025
Browning M, Fletcher P, Sharpe M (2011) Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review. Psychosom Med 73:173–184
Buffington CA (2009) Developmental influences on medically unexplained symptoms. Psychother Psychosom 78:139–144
Creed F, Barsky A (2004) A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res 56:391–408
Difede J, Barchas JD (2010) Psychiatric and neurologic aspects of war: an overview and perspective. Ann N Y Acad Sci 1208:1–9
Elklit A, Christiansen DM (2009) Predictive factors for somatization in a trauma sample. Clin Pract Epidemiol Ment Health 5:1
Engdahl B, Dikel TN, Eberly R et al (1998) Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war. Am J Psychiatry 155:1740–1745
Etkin A, Pittenger C, Polan HJ et al (2005) Toward a neurobiology of psychotherapy: basic science and clinical applications. J Neuropsychiatry Clin Neurosci 17:145–158
Fink P, Schroder A (2010) One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res 68:415–426
Ford JD, Campbell KA, Storzbach D et al (2001) Posttraumatic stress symptomatology is associated with unexplained illness attributed to Persian Gulf War military service. Psychosom Med 63:842–849
Franklin TB, Russig H, Weiss IC et al (2010) Epigenetic transmission of the impact of early stress across generations. Biol Psychiatry 68:408–415
Geuze E, Westenberg HG, Jochims A et al (2007) Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry 64:76–85
Glaesmer H, Gunzelmann T, Braehler E et al (2010) Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey. Int Psychogeriatr 22:661–670
Goldberg RT, Pachas WN, Keith D (1999) Relationship between traumatic events in childhood and chronic pain. Disabil Rehabil 21:23–30
Grabe HJ, Meyer C, Hapke U et al (2003) Somatoform pain disorder in the general population. Psychother Psychosom 72:88–94
Grant M, Threlfo C (2002) EMDR in the treatment of chronic pain. J Clin Psychol 58:1505–1520
Gundel H, Valet M, Sorg C et al (2008) Altered cerebral response to noxious heat stimulation in patients with somatoform pain disorder. Pain 137:413–421
Hasin D, Katz H (2007) Somatoform and substance use disorders. Psychosom Med 69:870–875
Henningsen P, Zipfel S, Herzog W (2007) Management of functional somatic syndromes. Lancet 369:946–955
Hessel A, Beutel M, Geyer M et al (2005) Prevalence of somatoform pain complaints in the German population. Psychosoc Med 2:Doc03
Hessel A, Geyer M, Gunzelmann T et al (2003) Somatoform complaints in elderly of Germany. Z Gerontol Geriatr 36:287–296
Kerns RD, Dobscha SK (2009) Pain among veterans returning from deployment in Iraq and Afghanistan: update on the Veterans Health Administration Pain Research Program. Pain Med 10:1161–1164
Kuwert P, Brahler E, Glaesmer H et al (2009) Impact of forced displacement during World War II on the present-day mental health of the elderly: a population-based study. Int Psychogeriatr 21:748–753
Kuwert P, Freyberger HJ (2007) The unspoken secret: sexual violence in World War II. Int Psychogeriatr 19:782–784
Kuwert P, Klauer T, Eichhorn S et al (2010) Trauma and current posttraumatic stress symptoms in elderly German women who experienced wartime rapes in 1945. J Nerv Ment Dis 198:450–451
Kuwert P, Spitzer C, Trader A et al (2007) Sixty years later: post-traumatic stress symptoms and current psychopathology in former German children of World War II. Int Psychogeriatr 19:955–961
Labbate LA, Cardena E, Dimitreva J et al (1998) Psychiatric syndromes in Persian Gulf War veterans: an association of handling dead bodies with somatoform disorders. Psychother Psychosom 67:275–279
Lahmann C, Henningsen P, Noll-Hussong M (2010) Somatoform pain disorder – overview. Psychiatr Danub 22:453–458
Lahmann C, Henningsen P, Noll-Hussong M et al (2010) Somatoform disorders. Psychother Psychosom Med Psychol 60:227–233 quiz 234
Leiknes KA, Finset A, Moum T et al (2007) Current somatoform disorders in Norway: prevalence, risk factors and comorbidity with anxiety, depression and musculoskeletal disorders. Soc Psychiatry Psychiatr Epidemiol 42:698–710
Maercker A, Forstmeier S, Enzler A et al (2008) Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey. Compr Psychiatry 49:113–120
Maercker A, Forstmeier S, Wagner B et al (2008) Post-traumatic stress disorder in Germany. Results of a nationwide epidemiological study. Nervenarzt 79:577–586
Mailis-Gagnon A, Nicholson K, Yegneswaran B et al (2008) Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic. Pain Res Manag 13:389–394
Meyer C, Rumpf HJ, Hapke U et al (2000) Lifetime prevalence of mental disorders in general adult population. Results of TACOS study. Nervenarzt 71:535–542
Muller JE, Wentzel I, Nel DG et al (2008) Depression and anxiety in multisomatoform disorder: prevalence and clinical predictors in primary care. S Afr Med J 98:473–476
Nickel M, Cangoez B, Bachler E et al (2006) Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: a randomized, controlled study. J Psychosom Res 61:507–513
Nickel R, Egle UT (2006) Psychological defense styles, childhood adversities and psychopathology in adulthood. Child Abuse Negl 30:157–170
Noll-Hussong M, Otti A, Laeer L et al (2010) Aftermath of sexual abuse history on adult patients suffering from chronic functional pain syndromes: an fMRI pilot study. J Psychosom Res 68:483–487
Paras ML, Murad MH, Chen LP et al (2009) Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA 302:550–561
Raphael KG, Widom CS (2011) Post-traumatic stress disorder moderates the relation between documented childhood victimization and pain 30 years later. Pain 152:163–169
Ringel Y, Drossman DA, Leserman JL et al (2008) Effect of abuse history on pain reports and brain responses to aversive visceral stimulation: an FMRI study. Gastroenterology 134:396–404
Rusby JS, Tasker F (2009) Long-term effects of the British evacuation of children during World War 2 on their adult mental health. Aging Ment Health 13:391–404
Schafer I, Von Leitner EC, Schon G et al (2010) Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One 5:e15941
Schneider G, Heuft G (2011) Medically unexplained and somatoform complaints and disorders in the elderly: a systematic review of the literature. Z Psychosom Med Psychother 57:115–140
Silver SM, Rogers S, Russell M (2008) Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans. J Clin Psychol 64:947–957
Thomas HV, Stimpson NJ, Weightman A et al (2006) Pain in veterans of the Gulf War of 1991: a systematic review. BMC Musculoskelet Disord 7:74
Valet M, Gundel H, Sprenger T et al (2009) Patients with pain disorder show gray-matter loss in pain-processing structures: a voxel-based morphometric study. Psychosom Med 71:49–56
Wessely S, Nimnuan C, Sharpe M (1999) Functional somatic syndromes: one or many? Lancet 354:936–939
Wittchen HU, Muller N, Pfister H et al (1999) Affective, somatoform and anxiety disorders in Germany–initial results of an additional federal survey of “psychiatric disorders”. Gesundheitswesen 61(Spec No):216–222
Wikipedia; http://en.wikipedia.org/wiki/File:Ongoing_Conflicts.png, accessed 17 February 2012
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Noll-Hussong, M., Glaesmer, H., Herberger, S. et al. The grapes of war. Z Gerontol Geriat 45, 404–410 (2012). https://doi.org/10.1007/s00391-012-0303-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00391-012-0303-9