Mental health articles

Pain disorder was previously known as somatoform pain disorder in DSM-III-R and as psychogenic pain disorder in DSM-III. The essential feature of pain disorder in DSM-IV  is a preoccupation with pain in one or more anatomical areas that is sufficiently severe to warrant clinical attention; that causes impairment in daily living; and psychological factors, it is judged, have a prominent role in the onset, exacerbation, and maintenance of pain. In addition, the pain is not intentionally produced or feigned and is not due to another affective or thought disorder or to dyspareunia. Unlike in the DSM-III-R, there is an attempt to identify subtypes of pain disorder in DSM-IV ased on the predominant factors that characterize the etiology and maintenance of the pain: pain disorder associated with psychological factors, pain disorder associated with both a psychological and a general medical condition, and pain disorder associated with a general medical condition.

In pain disorder associated with psychological factors, psychological factors, it is judged, have primary influence on the onset, exacerbation, and maintenance of the pain. A general medical condition plays little or no role in the etiology of pain in this subtype. In addition, this subtype cannot be diagnosed if the criteria for somatization disorder are met. As the name implies, both psychological factors and a general medical condition play an important role in the etiology of pain in the second subtype of pain disorder. The anatomical site or associated medical condition is coded on Axis III (e.g., diabetic neuropathy). In the third subtype of pain disorder, pain is due to a medical condition, is coded on Axis III, and is essentially not a mental disorder. In the first subtype of pain disorder, the duration of pain can be specified as acute if less than 6 months and chronic if longer than 6 months. Nosologically, the history of pain disorder continues to be one of the least satisfactory of the somatoform disorders.

Very few studies in the pain literature have ever used a DSM conceptualization. King and Strain noted that only five studies had used somatoform pain disorder based on DSMIII-R criteria. The difficulty with this category is inherent in the complicated and experiential nature of pain. Pain is a multifaceted experience characterized by affective, sensory, and evaluative components. Although pain can be simultaneously pathogenic and psychogenic, the correlation between the subjective report of pain and the physiological evidence of pain is relatively low. Other problems include the fact that the majority of chronic pain patients have pain in one or more areas, so that the majority of chronic pain patients would meet this first criterion. The remaining criteria for pain disorder are equally overinclusive, and most chronic pain patients report that pain interferes with social, occupational, and other domains of functioning and that psychological factors play a role in the etiology of pain. Chronic pain patients are bound to be affected physically and psychologically; however, they do not necessarily have to be psychiatrically disturbed.

Tags: disorder, DSM-IV, pain, pain disorder