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 ] :
