Pain and alexithymia: The nature of a relation

Alexithymia is a personality disposition, found in patients with different diseases, characterized by difficulty in identifying emotions or differentiating between sensations and emotions and a concrete thinking style. This review focuses on the relation of alexithymia and chronic pain. The first section deals with studies (n = 20) comparing the alexithymia scores of chronic pain patients with norms or control groups (the 'between group design'). Despite the variety of samples and assessment tools, the great majority of studies showed that chronic pain patients are more alexithymic than healthy controls as well as other types of medical or psychiatric patients. The second section deals with the correlates of alexithymia in chronic pain patients (the 'within group design'). The findings show that alexithymia is mostly unrelated to demographic or clinical features of pain as well as to psychopathology, but is related to diffuse pain descriptions, somatic complaints, inhibited anger, anxiety, passivity, limited social relations, hysteria, hypochondriasis and upholding a positive facade. Major implications are that alexithymia is a primary phenomenon and not merely a reaction to pain, that pain patients dispose of poor means for controlling pain, and that psychopharmacological and behavioral interventions are more likely than psychotherapeutic methods to be helpful to these patients.