The diagnosis 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
The patient'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.
Disorders (Mood, Anxiety, Psychotic) do not explain the symptoms better,
and the patient
does not meet criteria for Dyspareunia.
The patient doesn't consciously feign the symptoms for material gain
(Malingering) or to occupy
the sick role (Factitious Disorder).
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
Pain disorder may develop due to a
conversion mechanism.. And quite a few patients 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. Needless to say, 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
(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.
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
Pain Disorder Associated with a General
Medical Condition may be treated with a course of general pain killers.. This term is used for any patient who has pain that
is mainly caused, worsened or maintained by a general medical condition,
so long as any psychological factors play at most a minor role. This is
not considered to be a mental disorder.
Disorders & Pain