A strange neuropsychological anomaly

29.07.2020

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 pain asybolism to see the implications of this pathology and what are the causes that may be causing this dysfunction in pain perception as we know it.

What is the asymbolia of pain

Pain assybolism, also known by the medical term of analgognosia, refers to an inadequate 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 the damage of the aversive stimulus (not removing the hand from the fire, for example), not expressing a gesture of pain in the face, or not showing a psychological reaction to the harmful element .

The expression of pain asybolism was coined by Paul Schilder and Erwin Stengel , neurologists, psychiatrists and also psychoanalysts, from 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, since as a result of this publication their own names were also used as nomenclature for this new discovered pathology.

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

Asymbolia of danger

The asymbolia of pain refers not only to experiencing pain, but also to seeking pain . Somehow, it would seem that the person suffering from this abnormality would try by all means to try to feel the damage, incredible as it may seem. For this reason, more and more intense self-attacks would be carried out, in an escalation to recover that lost sensation, no matter how unpleasant it was.

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 level of response, since it continues to be harmful) and Consequently, the individual tends to experience more and more, attracted by the performance of harmful behaviors, which do not involve any pain.

The big problem with this question is that, although the patient has lost the ability to feel pain, the injuries he is self-inflicting are real, so he may experience serious sequelae organically , depending on how intense these behaviors have been. . For this reason, sometimes the concept of asymbolism for danger is also discussed, since they are not aware of the harm they are causing themselves in their search for the sensation of pain.

Causes

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

It is considered that the specific area that would be directly involved with pain assybolism would be number 43 within Brodmann's list of areas. By suffering an injury 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 the patients affected by this pathology do not have the physical capacity to relate the aversive stimulus with the painful reaction before it, because they are not capable of processing it.

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

Comorbidity

The asymbolism of pain also has the peculiarity that it can be linked to other pathologies of different kinds , such as Wernicke's aphasia (difficulties in understanding the language), conduction aphasia (problems repeating words), constructive apraxia (loss of the ability to make movement patterns to build elements or to draw).

They are not the only disorders that can occur as an associated morbidity of pain assybolism . Others would be ideomotor apraxia (problems in carrying out thought movements in the mind), autotpoagnosia (difficulty perceiving the determined position of a part of the body itself) or aprosodia (impaired ability to correctly perform or interpret the sound characteristics of the body). language, that is, prosody).

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

Other pain disorders

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

Another disorder quite popular for its symptoms is PLP, or phantom limb pain . This ailment manifests itself in some people who have suffered an amputation of one of its limbs, be it an arm or a leg, and yet suffer recurrent pain in that 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 a treatment that relieves him.

In fact, one of the techniques used to alleviate the pain of PLP is that of mirrors, in which, visualizing the healthy limb in front of a mirror, it tries to focus on the pain sensations of the phantom limb. 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 extreme of pain asybolism, we would find a disorder as frequent 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 wide disorder that affects each person differently and therefore it is difficult to generalize an effective treatment.

Also in disorders opposite to the pain asybolism 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 an abnormally high sensation of pain in relation to the aggression of the damaging stimulus that is triggering it.

Finally, another pathology associated with pain but also found in the opposite pole with respect to pain asybolism, would be allodynia . It would also imply an excessive perception of the painful sensation, but in this case it would not be caused by an aversive stimulus, 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, so that contact with a substance at pleasant temperatures could also trigger a perception of immense pain in the subject , as if the stimulus were at a very low or very high temperature, when in reality it would be at room temperature, so it should not cause any pain.

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