Pain disorder

Pain disorder Treatment, Cause, Symptoms, Medication

Pain Disorder (like conversion disorder) is a form of somatoform disorder.

A disorder in which pain in one or more anatomic sites is exclusively or predominantly caused by psychologic factors, is the main focus of the patient's attention, and results in significant distress and dysfunction.

Pain Disorder is a somatoform disorder in which the predominant area of focus is painful bodily complaints in which psychological factors are determined to be central to the onset, severity, exacerbation or maintenance of the complaint.

DSM Code -- 307.80

Diagnostic criteria for Pain Disorder

1. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.
2. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
4. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering ).
5. The pain is not better accounted for by a Mood, Anxiety, or Psychotic Disorder and does not meet criteria for Dyspareunia.

Symptoms of Somatoform Pain Disorder

Pain associated with psychologic factors is common in many psychiatric conditions, especially mood and anxiety disorders, but in pain disorder, pain is the predominant complaint. Any part of the body may be affected, but the back, head, abdomen, and chest are probably the most common.

The primary symptom of pain disorder is chronic pain for several months that limits a person's social, occupational, or recreational abilities.

Cause of Pain disorder

Pain disorder may develop due to a conversion mechanism and some patients may have what is called a "pain-prone personality:" they have long-standing feelings of guilt and worthlessness about themselves, and they chronically feel that they are in need of punishment or atonement, pain gives them this.

Unfortunately, pain that is "psychological" in nature is often stigmatized both by medical professionals and the general public. A poor understanding of the connections between mind and body can lead to the misperception that if pain has a psychological cause it isn't "real" and should be able to be controlled without medical or mental health treatment.

Treatment of pain disorder

The treatment of pain associated with a psychiatric disorder is the treatment of the primary condition. Skill is required to maintain a working relationship with patients unwilling to accept a psychological basis for their pain. Any associated physical disorder should be treated and adequate analgesics provided.

The management of chronic pain should be individually planned, comprehensive, and involve the patient's family. Any physical cause must be treated. Psychological care is directed to two issues:

• whether there is an associated mental disorder. This assessment should be made on positive findings and not solely because no specific organic cause has been identified. If depressive illness is present it should be treated vigorously. Antidepressant medication may also be effective in patients with chronic pain in the absence of evidence of a depressive disorder (O'Malley et at 1999).
• whether the pain or any associated behaviors can be modified by using psychological techniques.

Behavioral treatments are useful. However, many patients with chronic pain lack the motivation needed to make full use of these methods. In some cases such treatment aims to reduce social reinforcement of maladaptive behavior, and to encourage the patient to seek ways to overcome disability. See Morley et at. (1999) for a review.

Pharmacological and behavioral therapies may be combined for some patients. Multidisciplinary pain clinics provide expertise in and resources for arrange of treatments. Although many patients are unwilling to accept such treatment and others are considered unsuitable, the evidence is that they are cost-effective for participants.

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Site last updated: March 4, 2008

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