Alexithymia and Somatization in Chronic Pain Patients: A Sequential Mediation Model

Roberta Lanzara; Chiara Conti; Martina Camelio; Paolo Cannizzaro; Vittorio Lalli; Rosa Grazia Bellomo; Raoul Saggini; Piero Porcelli

doi:10.3389/fpsyg.2020.545881

Alexithymia and Somatization in Chronic Pain Patients: A Sequential Mediation Model

Front Psychol. 2020 Oct 27:11:545881. doi: 10.3389/fpsyg.2020.545881. eCollection 2020.

Authors

Roberta Lanzara^{1

2}, Chiara Conti², Martina Camelio², Paolo Cannizzaro³, Vittorio Lalli³, Rosa Grazia Bellomo⁴, Raoul Saggini⁵, Piero Porcelli²

Affiliations

¹ Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy.
² Department of Psychological, Health and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
³ Department of Anesthesia and Intensive Care, Regional Pain Unit, University Hospital SS. Annunziata, Chieti, Italy.
⁴ Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy.
⁵ Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio", Chieti, Italy.

Abstract

Objective: To investigate whether chronic pain (CP) patients with somatization reported higher alexithymic traits than those without somatization and to study the different relationships between psychological characteristics, pain, health-related quality of life (HRQL), and somatization.

Method: A consecutive sample of 134 CP treatment-seeking outpatients were evaluated for alexithymia (TAS-20), somatization (PHQ-15), distress (HADS), HRQL (SF-12), and pain (BPI).

Results: Patients with somatization (37.04%) reported significantly higher TAS-20 total scores (p < 0.001) and difficulty in identifying feelings (DIF) (p < 0.001) than those without somatization. The somatizer group had also a significantly higher disease duration, severity and interference of pain, distress, and lower HRQL than the non-somatizer group. Hierarchical regression analysis showed that although distress, pain interference and the mental HRQL component are closely related to somatization (R ² = 0.55), DIF was the strongest predictor of severity of somatization (β = 0.31). A sequential indirect effect from DIF to somatization via distress symptoms and pain interference turned out to be significant [95% CI (0.01, 0.09)]. Support was also found for sequential mediation paths from DIF to somatization via distress and mental HRQL [95% CI (0.01, 0.11)].

Conclusions: Our results pointed-out that alexithymia, particularly DIF, may be major factor for somatization risk in CP patients. Longitudinal observations are needed for evaluating the role of alexithymia in clinical outcomes.

Keywords: alexithymia; chronic pain; distress; quality of life; somatization.