Symbolism of pain: features, symptoms and causes

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

Let us delve into the subject of the symbolism of pain to see the implications of this pathology and what are the causes that may be at the origin of this dysfunction in the perception of pain as we know it.

    What is the symbolism of pain

    Asymbolic pain, also known by the medical term analgesia, refers to an inappropriate reaction to a painful stimulus, Due to difficulties in identifying it. Some of these reactions may be not removing the painful part of the body from the aversive stimulus (not removing the gun, for example), not expressing pain in the face, or not showing pain. psychological reaction to the harmful element. .

    The expression of pain symbolism was invented by Paul Schilder and Erwin Stengel, Neurologists, psychiatrists and other psychoanalysts, from a study conducted in 1927. In fact, in some textbooks it is possible to find the Schilder-Stengel syndrome to denote the symbolism of pain, because this publication also used his own names as nomenclature for this new pathology discovered.

    The case these researchers investigated was of a woman with sensory-type aphasia who repeatedly injured herself, showing no reaction to the pain she would be expected to feel in the face of a massive assault on her body. . Tests were carried out with electrical stimulation, of increasing intensity, and it was only in the upper ranks that they obtained a facial response to the aversive stimulusBut at no time did he attempt to escape from the aircraft.

    Symbolism of danger

    The symbolism of pain it refers not only to a feeling of pain, but also to its search. Somehow, it would seem that the person suffering from this anomaly is trying by all means to try to feel the hurt, unbelievable as it may seem. This is why more and more intense attacks would be carried out, in an escalation to recover this missing feeling, as unpleasant as it is.

    And is although the subject perceives the stimulus that hurts him, his body is disconnected from the painful response he should give., So that the stimulus loses the aversive component (only at the response level, because it remains harmful) and consequently the individual tends to feel more and more, attracted by the performance of harmful behaviors, which do not involve no pain.

    The big problem with this problem is that even though the patient has lost the ability to feel pain, the self-inflicted injuries are real, so may have serious organ sequelae, Depending on the intensity of these behaviors. This is why the concept of danger symbolism is sometimes also brought up, as they are not aware of the harm that is generated in their search for the sensation of pain.

    the causes

    But what is the origin of the symbolism of pain? This pathology seems to come from organic lesions of the brain, More precisely in the left parietal lobe or in both hemispheres at the same time, and more precisely in the supramarginal rotation, affecting the insula or the insular cortex, the Silvio slit. The injury could result from a cranioencephalic trauma or from a pathology of an internal nature affecting this area.

    The specific domain that would be directly involved in pain symbolism is considered to be number 43 in Brodmann’s list of domains. When you have an injury in this region of the cerebral cortex, the connections between the sensory system and the limbic system would be removed, Which would explain that the patients affected by this pathology do not have the physical capacity to link the aversive stimulus to the painful reaction to it, because they are not able to treat it.

    Depending on the severity of the injury, it is possible to experience partial or complete pain in the form of symbolism, depending on whether the aforementioned connections have been completely destroyed or whether there are still active neural circuits capable of transmitting, although that in part, the information relating to the absorption of pain in the receptors of the body and thus results in a consequent reaction, which will generally be much less than it should be, to perceive only a part of the intensity of the stimulus.


      The symbolism of pain also has the peculiarity that it may be linked to other pathologies of a different nature, Such as Wernicke’s aphasia (difficulty understanding language), motor aphasia (problems with repeating words), constructive apraxia (loss of the ability to create movements to build items or draw).

      These are not the only disorders that can arise as morbidity associated with pain and symbolism.. Others would be ideomotor apraxia (problems executing movements designed in the mind), autotpoagnosia (difficulty perceiving the determined position of a part of one’s body) or aprosody (impaired ability to perform or correctly interpret the sound characteristics of language, i.e. prosody.).

      It is not uncommon that there are a variety of neurological disorders that can appear in the patient along with pain and symbolism, since it should be remembered that these pathologies are caused by head trauma, it is not It is therefore not uncommon for the same lesion to affect different areas of the brain which, although contiguous, have very different functions and can therefore trigger symptoms as varied as we have seen.

      Other pain disorders

      But symbolism is not the only pain-related disorder. There are others with very specific characteristics. For example, we find analgotemia, a condition in which the patient feels pain caused by an aversive stimulus, Is able to identify and locate him without any problem, yet shows absolutely indifference on an emotional level. The two disorders would share a lack of response to pain, but in the latter case, the sensation is felt.

      Another very popular disorder for its symptoms is PLP, or phantom limb pain.. This disease manifests itself in some people who have had an amputation of one of their limbs, whether an arm or a leg, and yet suffer from recurring pain in this part of the body, which is no longer present. It may seem that this pathology escapes logic, but the patient experiences a real sensation and therefore needs treatment that relieves it.

      In fact, one of the techniques used to relieve the pain of PLP is that of mirrors, in which, by visualizing the healthy limb in front of a mirror, he tries to focus on the pain sensations of the phantom limb. Some studies show that this technique helps calm these sensations, leading to improvement in the PLP patient.

      The opposite case

      And, at the other end of the symbolism of pain, we would find a disorder as common in our society as fibromyalgia, A disease that causes hypersensitivity to pain, with no apparent specific cause and can also spread to different areas of the body, and can cover a large part of it. The big problem with fibromyalgia is that it is a very common disorder, affecting each person differently and therefore it is difficult to generalize effective treatment.

      Also in the disorders opposed to the pain symbolism, we can find the pathology known as hyperalgesia. This disease is thought to be caused by damage to the nervous system and makes the subject feel abnormally high in pain in relation to the aggression of the noxious stimulus which triggers it.

      To finish, another pathology associated with pain but also at the opposite pole compared to the symbolism of pain, would be allodynia. This would imply also a disproportionate perception of the painful sensation, but in this case it would not be caused by an aversive stimulus, but by a stimulus which in principle should be neutral, such as tactile pressure and even a simple caress in some cases.

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

      Bibliographical references:

      • Gil, R. (2003). Neuropsychology. Barcelona. Elsevier.
      • Kim, SY, Kim, YY (2012). Mirror therapy for phantom limb pain. The Korean Pain Journal.
      • Piulachs, P., Vara, R. (1974). The meaning of pain. Institute of Spain. Royal National Academy of Medicine.
      • Schilder, P., Stengel, E. (1931). Assimilation for pain. Archives of Neurology and Psychiatry.

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