Male’s Health in the Objective of Stressology – Beyond the Usual. Армен Мурадян

echo-stressors” can be exemplified by various somatic conversions well known to psychiatrists, neuropathologists, psychotherapists. It is common knowledge that in contrast to the somatoform manifestations, conversions never give way to organic changes. Functional disorders never convert to the structural ones, even when frequently repeated. Probably, the somatic conversions are stipulated only by the first level of the stress process or the autonomous nervous axis providing only a bioelectrical effect, without involvement of endocrinal axes or hormones.

      Pain “flashback”. The most common is somatic-pain syndrome of various localizations. Phantom pains also relate to this category.

      Example: Five years ago, a patient having fallen on the stairs experienced a terrible pain in her back, which then gradually ceased. She did not pay much attention to this since there was clearly no fracture. However, after a while, about a week, the pain resumed and did not pass. X-ray and other examinations did not reveal any abnormalities, but the pain became chronic despite the ongoing therapeutic measures. The pain occurred even when she accidentally touched the furniture. “As if I fell down the stairs again”,– the patient said. The pain recurred many times. Sometimes the pain appeared all of a sudden when she was watching TV: “I did not touch anything, but the pain is there! I cannot walk; I hardly do something around the house. But what is really strange is that a sharp sound, sometimes even an ordinary conversation or a draft cause attacks of the same pain”. Gradually she began to limit herself in mobility, ceased going out, bought crutches, became disabled. The pain sharpened with physical or mental loads”.

      An example is well-known to orthopedists phantom pains when a person experiences severe pain in the amputated part of the leg. Analgesics do not bring relief from this suffering and the pain remains there for several years. Both phantom and chronic pains in the back are not related to the current external injuries. The pain effect had a real cause but it happened in the past, once and in a specific place – “Then and There”. Now the pain appears anywhere, anytime. As the patient describes, “appears when it wants to appear. It does not change, does not increase or does not fade with time, as if it is stuck in me and under some conditions makes itself felt: “I’m here, I’m in you”. Indeed, pain has become part of human body and life.

      Example: “Two years have elapsed since I suffered herpes in the waist (lumbar region) and chest. All the external signs have long since passed; there are no changes on the skin. But it is hard to imagine what pains I am experiencing. As soon as I come home, and now I live alone, itching and pains seem to be waiting for me at home. Nothing helps. I was examined – no deviations. But the pain does not leave me, and it is always the same – with itch”.

      A person experiences pain in the absence of bodily injuries and moreover, such pain is as real for a person as a physiological one. It is not “imaginary”. As distinct from the primary pain, chronic does not calm down with time, its appearance does not have spatial and time boundaries, analgesics do not help, antidepressants give a temporary relief. In neurology, such pain is known as neuropathic. In psychiatry – as a “chronic pain syndrome”, which is treated as psychalgia (mental pain), equated with it and included into the group of somatoform disorders (ISD–10/F–45).

      Anxiety and pain are signals of danger but of different levels: pain is a signal of danger to the body, and anxiety – for the psyche of an individual. These protective reactions, similar in their discreteness, are due only to the autonomous bioelectric mechanism of the first phase of stress reaction. If there is a fixation of pain sensory stimulation, then it becomes obsessive and can be attributed to a bodily flashback symptom.

      Studies of recent years make it possible to understand why the amputated limb hurts; why symptoms of herpes persist after the disappearance of all objective manifestations; why a pain syndrome persists in some people when there is not even a scar left from an injury or wound, not to mention some internal injuries. A differential sign that distinguishes the pain “flashback” from other numerous manifestations of the pain syndrome is its paroxysmal character independent of place and time and not changing its qualitative characteristics: localization, the character of pain over a long time.

      As far back as 1894, the German neuropathologist and psychiatrist Franz Kisel showed that nerve injury led to significant changes in glia cells in the area of nerve fiber switching in the spinal cord. At the same time the number of microglia cells increased, astrocytes became denser, and thick bundles of fibers that strengthen cytoskeleton appeared in them. A hundred years later, in 1994, Stephen Meller from the University of Iowa proved the participation of glia astrocytes in the formation of chronic pain. Further studies shed light on the mechanism of this phenomenon. Glia cells secrete various substances capable of increasing the excitability of neurons of spinal ganglia and spinal cord responsible for the transmission of pain sensitivity. Such substances include also growth factors. It has been found that glia cells perceive enhanced impulse from neurons as a sign of their functional tension. With these data, a real opportunity appeared to explain one of the mechanisms of obsession (involuntary repeatability). According to them, with bodily injury, the pain “excitability” in the glia of the spinal cord can persist for too long and then the neurons of spinal ganglia continue to send pain impulses in the absence of external irritants. These effects resemble mental flashbacks in PTSD. It can be assumed that the glia of the brain as a memory carrier and its cells or groups of cells retain enhanced excitability. The latter is considered as the main cause of neuropathic pain in neurology. The injured body, when confluence of some factors, is able to preserve the memory of trauma at different levels of pain formation, using different links of the same process – the process of feeling pain. The aftereffect of traumatic injury in the form of a trace pain “echo-stressor” can become stuck in glia cells of the spinal cord, astrocytes and microglia cells. The glia cells themselves are not capable of impulses, but they are capable of capturing neurotransmitters – substances released by the endings of nerve fibers and providing signal transmission from one neuron to another.

      Example: All my life, as long as I can remember, I have been sensitive to the pain of others at the bodily level. Someone fell – I have pain and feel creepy all over, got wounded – synchronously with him I feel pain in the body. Once in the third year of the Medical Institute during a practical lesson in surgery we were taught spinal puncture. As soon as the needle entered the spinal canal of the patient – I reacted: having experienced pain, I was covered with cold sweat and fell into a subconscious state. Becoming a professional, I began to analyze the events of childhood, life, memories. Looking back at everything that happened in my childhood, I recall my first experience of feeling pain in the body, the experience of curiosity and pain. It was the first year after the war. My father was awarded a sanatorium trip. I was 9 years old then, and father took me to Georgia, to the Black Sea. It was a fairy world where I was amazed at everything: palm trees, salt water in the sea, huge white flowers on the trees – magnolia, in the air the aroma of oleander, roses, flourishing lemons and oranges. And I touched everything, picked flowers, leaves; I ate melons and watermelons for the first time in my life. One evening guests came to us and while they were sitting at the table I went out into the garden. The sun had already set, twilight came and the shape of the surrounding trees and bushes became vague. I stopped at the plant which I had never seen before, it was very strange, and at the top there was a flower of marvelous beauty and some other fruits. I grabbed the plant with both hands, pressed it to me and the same moment screamed, screamed in pain in the whole body, incomprehensible, sharp and stabbing. Hundreds of needles pierced me. It was cactus. I screamed, but I could not get rid of the pain and the plant. The dog ran from me to the house and barked loudly. I screamed in pain, it barked until the adults heard. My memory did not keep everything, I remember only that I was given cognac and all amicably began to pull out bundles of thorns that pierced my body. Even the next day my grandmother still found needles. Since then, I hate cacti and synchronously feel pain when someone nearby feels it. Even when I watch a TV program about “black humor” I am pierced with pain or shiver all over if suddenly someone fell or got injured.

      The examples cited above unveil the mysteries of intracerebral activity and make it possible to look at facts differently. If a person encounters the