The diagnosis of
Pain Disorder is made in patients when pain has existed for at least
six months and there is strong evidence that psychological factors have
caused or are maintaining the pain. Many of these patients have depressive
illnesses, and in some of them major depression may be the root cause.
The main diagnostic criteria is as follows:
The person's presenting problem is clinically important pain in one
or more body areas.
The pain causes distress that is clinically important or impairs work,
social or personal functioning.
Psychological factors seem important in the onset, maintenance, severity
or worsening of the pain.
Other Disorders (Mood,
Anxiety, Psychotic) do not
explain the symptoms better, and the patient does not meet criteria
for Dyspareunia.
The person doesn't consciously feign the symptoms for material gain
(Malingering) or to occupy the sick role
(Factitious Disorder).
Associated Features:
Musculoskeletal
conditions.
Neuropathies.
Malignancies (eg, bone metastases, tumor infiltration of nerve).
Comorbidity.
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate against
the following disorders which need to be ruled out to establish a precise
diagnosis.
Osteoporosis.
Osteoarthritis.
Fibromyalgia.
Cause:
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. Physical pain may play such a role, and the onset of the pain
may be seen in these patients when things seem to be going otherwise
unexpectedly well in their lives. There is some association between
this personality style and a history of childhood (and subsequent adult)
abuse and/or victimization. Others, often
women, experience pain for which no cause can be found.
It appears suddenly, usually after a stress, and may disappear
in days or last years.
Treatment:
The goal of treatment
is to ease the pain and help the person learn how to live with it. Invasive
evaluations and surgical interventions should be avoided if possible.
Psychiatric referrals
may be helpful, though many people with this disorder resist psychiatric
interventions. Some patients with a somatoform pain disorder rarely
acknowledge that their illness has a psychological component and will
usually reject psychiatric treatment.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
