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[From back pain to life-discontent. A holistic view of psychopathological contributions to pain].

Back pain is a common and disabling condition; it afflicts young adults, and often pursues a chronic course--representing a major public health problem. The physical component of such pain is often overestimated. This paper describes five cases demonstrating how somatic factors can interact with psychological and psychiatric factors--i.e. the 'psychoaffective context'--to determine the degree of perceived pain. In a schema, we summarize the three ways in which the psychoaffective context may contribute to pain: i) physiologically, as a result of increased arousal, leading to muscle tension and perceptual hypervigilance, ii) emotionally, as a result of anxiety leading to stress and feeling of threat, and iii) cognitively, as a cognitive bias caused by increased attention to signals from the target region, and by an increased tendency to interpret these signals as aversive. Personality factors, autobiographical memory, and the place devoted to the body within the narcissistic equilibrium contribute to the degree of anxiety and cognitive bias. Moreover, anxiety and the cognitive bias are also exacerbated by the depressive syndrome that often accompany such pain. Collectively, these factors can lead to a somatization disorder and to chronic pain, even in response to an experience of minimal pain.