Pain Disorder

The diagnosis of pain disorder is subject to the usual restrictions, that it cause clinically significant distress or impairment, and that it not be better diagnosed as a result of another mental disorder. In addition, the pain must be real. If the pain is primarily the result of a general medical condition, it is not a mental disorder. That leaves two types of pain disorder that are diagnosed as mental disorders: pain that is associated with psychological factors, and pain that is associated with both psychological factors and a general medical condition. Separating the three subclasses of pain disorder is no easy task, and requires very careful diagnostic work by a skilled professional. The percentage of people who suffer significantly from pain in a given year is surprisingly high; the authors of DSM-IV place the percentage of adults who suffer from back pain alone in a given year at 10 to 15. It is likely, however, that psychological factors account for the pain in a relatively small fraction of these cases. There are many other sources of pain that may be clinically significant; among them are headaches, especially migraine headaches, the effects of injuries, and the intractable pain that sometimes accompanies end-stage cancers.

Most pain is, fortunately, relatively short-lived. In many cases the best therapy is to continue normal activities if possible. Difficulties arise if the sufferer allows the pain to become the focus of life over a long period of time, so that psychological factors take over when the medical condition has remitted. Nevertheless, mental health professionals must not assume at the outset that pain has no physical cause. Only after very careful examination by a physician can physical factors be ruled out, and people with persistent and unremitting pain should be reexamined to be sure that there is no physical condition that needs treatment.

Many people suffering from pain also have another mental disorder, in particular Major Depression, which should be diagnosed instead of pain disorder unless the pain is great enough to demand independent treatment. Professionals who treat pain disorder related to medical conditions often prescribe narcotics in too small quantities and not frequently enough. A frequent error is waiting until the pain builds up before administering anesthetics, rather than preventing the pain altogether. It is becoming common practice to allow patients to self-administer the narcotics so that the pain is better controlled, but patients may make the same error. 

Patients with chronic pain are often helped by antidepressants and various kinds of activity and group therapy. Pain clinics are expert in administering appropriate drugs and therapy, and the majority of patients who suffer from long-term pain, despite the usual medical treatment, improve after treatment in a specialized pain center.