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Pain Disorder
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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.

Counseling and Psychotherapy [ See Therapy Section ]:

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 ] :

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.

 


DSM Code

307.89 Pain Disorder Associated with ...

307.80 Pain Disorder Associated with Psycological factors

F45.41 Pain Disorder

Disorder Sheets

Action on Pain
Action on Pain
PO Box 134
Shipdham
Norfolk
IP25 7XA
Tel: +441362820750
Painline:+448456031593
Email: Click Here
Web: Click Here

Recommended Book

Transforming the Pain: A Workbook on Vicarious Traumatization - Click Here to View

Pain Disorder

Misc Information

None

Somatoform Disorder's

Pain Management