Pain disorder Health Article

Definition

Pain disorder is one of several somatoform disorders described in the revised, fourth edition of the mental health professional's handbook, the Diagnostic and Statistical Manual of Mental Disorders(known asDSM-IV-TR). The term "somatoform" means that symptoms are physical but are not entirely understood as a consequence of a general medical condition or as a direct effects of a substance, such as a drug. Pain in one or more anatomical sites is the predominant complaint and is severe enough to require medical or therapeutic intervention. Pain disorder is classified as a mental disorder because psychological factors play an important role in the onset, severity, worsening, or maintenance of pain.

Earlier names for this disorder include psychogenic pain disorder and somatoform pain disorder. There is some overlap in the meaning of these terms, but views regarding the nature of pain have been changing and they are, therefore, not equivalent diagnostic categories. Sometimes pain disorder is referred to as somatization, but this is an imprecise term and is easily confused with somatization disorder.

Description

In 1994, the International Association for the Study of Pain (IASP) defined pain as an unpleasant sensory or emotional experience arising from real or probable tissue damage. In other words, the perception of pain is, in part, a psychological response to noxious stimuli. This definition addresses the complex nature of pain and moves away from the earlier dualistic idea that pain is either psychogenic (of mental origin) or somatogenic (of physical origin). The contemporary view characterizes pain as multidimensional; the central nervous system, emotions, cognitions (thoughts), and beliefs are simultaneously involved.

When a patient's primary complaint is the experience of pain and when impairment at home, work, or school causes significant distress, a diagnosisof pain disorder may be warranted. The diagnosis is further differentiated by subtype; subtype is assigned depending on whether or not pain primarily is accounted for by psychological factors or in combination with a general medical condition, and whether the pain is acute (less than six months) or chronic (six months or more). The classification of pain states is important since the effectiveness of treatment depends on the aptness of the diagnosis of pain disorder and its type.

Causes

Common sites of pain include the back (especially lower back), the head, abdomen, and chest. Causes of pain vary depending on the site; however, in pain disorder, the severity or duration of pain or the degree of associated disability is unexplained by observed medical or psychological problems.

The prevailing biopsychosocial model of mental disorders suggests that multiple causes of varying kinds may explain pain disorder, especially when the pain is chronic. There are four domains of interest:

• The underlying organic problem or medical condition, if there is one. For example, fibromyalgia (a pain syndrome involving fibromuscular tissue), skeletal damage, pathology of an internal organ, migraine headache, and peptic ulcer all have characteristic patterns of pain and a particular set of causes.
• The experience of pain. The severity, duration, and pattern of pain are important determinants of distress. Uncontrolled or inadequately managed pain is a significant stressor.
• Functional impairment and disability. Pain is exacerbated by loss of meaningful activities or social relationships. Disruption or loss may lead to isolation and resentment or anger, which further increases pain.
• Emotional distress. Depression and anxiety are the most common correlates of pain, especially when the person suffering feels that the pain is unmanageable, or that the future only holds more severe pain and more losses.

In sum, there are multiple causes of pain disorder. A therapist or team of health professionals will weigh the relative causal contributions, assign priorities for therapeutic intervention, and address the several domains in a multimodal fashion. For example, the design of a treatment plan in a pain clinic may involve a physician, psychotherapist, occupational therapist, physical therapist, anesthesiologist, psychologist, and nutritionist.

Symptoms

Symptoms vary depending on the site of pain and are treated medically. However, there are common symptoms associated with pain disorder regardless of the site:

• negative or distorted cognition, such as feeling helpless or hopeless with respect to pain and its management
• inactivity, passivity, and/or disability
• increased pain requiring clinical intervention
• insomniaand fatigue
• disrupted social relationships at home, work, or school
• depression and/or anxiety