Pain disorder: what it is, causes, symptoms and treatment

somatoform disorders they carry a series of physical symptoms that are not explained by any medical condition. In addition, they have the characteristic that there are a series of basic psychological factors that are related to their onset, maintenance, or exacerbation.

In this article we will learn about one of these disorders: the pain disorder, in which the main symptom is intense and disabling pain. We will see what are its characteristics, types, symptoms, causes and treatments.

Pain disorder: what is it?

Pain disorder is a disorder belonging to the category of "somatoform disorders" of the DSM-IV-TR (APA, 2002). In the DSM-5 (APA, 2013), this category is renamed "Somatic Symptom Disorders and Related Disorders."

Besides, An important change to note is that the pain disorder disappears as such in this new edition of the DSM., and becomes a specifier of somatic disorders.

Let's see what somatoform (or somatoform) disorders are, such as pain disorder.

somatoform disorders

Somatoform or somatoform disorders

They encompass a group of mental disorders characterized by the appearance of a series of physical symptoms that are not explained by any medical condition.; however, these symptoms are related to psychological factors, such as traumatic events.

It is important to differentiate somatoform disorders, such as pain disorders, from psychosomatic disorders or illnesses. The latter are organic pathologies or known and specific pathophysiological processes, where psychological and psychosocial factors are related to their onset or course.

Characteristics

Pain disorder, which is listed as a diagnosis in the DSM-IV-TR, was previously called "somatoform pain." It was also called “chronic pain”, a term first used by Keefe in 1982.

Regarding its epidemiology, pain disorder is the most prevalent of all somatoform disorders in the clinical setting. It appears more frequently in women than in men, especially as symptoms related to menstrual pain.

Symptoms

We are going to see the main symptoms of pain disorder, which in turn correspond to its diagnostic criteria.

1. Pain

As its name indicates, the main symptom of a pain disorder is localized pain in one or more areas of the body. This pain is severe enough to require specific clinical attention.

2. Discomfort

This pain causes significant discomfort in the patient. This discomfort can also lead to deterioration in the person's life, and is also clinically relevant. That is to say, that it is significant and that it is not reduced to a simple feeling of discomfort.

3. Psychological factors

Besides, the pain disorder is associated with a series of psychological factors that play a determining role in the pain itself; that is, said factors significantly influence the onset, course, maintenance, or worsening of the pain symptom.

It should be mentioned that when the pain appears associated with a medical condition, this could not be considered a mental disorder.

4. there is no simulation

Finally, the patient does not simulate this pain in any way, nor does it intentionally produce it. This feature would differentiate it from simulation.

Guys

In the DSM-IV-TR it is necessary to code the type of pain disorder manifested by the patient, which can be of two types.

1. Pain disorder associated with psychological factors

In this case, there are a number of psychological factors (for example, anxiety experienced by stressful life events, traumatic experiences, nervousness, etc.) that explain why the pain symptom started, why it became exacerbated or why it persists over time.

That is, these factors play a relevant role in the onset, maintenance, and/or worsening of pain.

2. Pain disorder associated with psychological factors and a general medical condition

In this second type of pain disorder, in addition to the psychological factors mentioned, there is also an underlying medical condition; although, we remark, these psychological factors must always exist, necessarily.

This subtype is more frequent than the previous one.

Specifiers

On the other hand, in the DSM-IV-TR it is also necessary to specify whether the pain disorder is acute or chronic.

1. Sharp

Acute pain disorder lasts for less than 6 months.

2. Chronic

In the case of diagnosing a chronic pain disorder, its duration is equal to or greater than 6 months.

It should be noted that in the WHO classification (ICD-10, International Classification of Diseases), there is also a diagnosis of pain disorder, and that in this classification the persistence of the pain symptom is at least 6 months (a requirement that the DSM-IV-TR does not have).

Causes

The causes of the pain disorder, as we have seen, are exclusively associated with psychological factors (which are usually be stressful for the person), or to psychological factors together with some type of medical illness that the patient suffers from. patient. Psychological factors include stressful or traumatic events for the patient, a fast pace of life that causes anxiety, a mismanaged grief, the death of a loved one, etc

But let's remember, the pain of a pain disorder can never be explained solely by a general medical condition., because then we would not be talking about this diagnosis or a mental disorder.

Treatment

The treatment of the pain disorder will include a psychological intervention aimed at treating the underlying causes of the pain.; in this case, the psychological factors that explain the pain symptoms. So the therapy must be personalized for each patient and adapted to each specific case, since the factors will always vary from one case to another.

can be used cognitive-behavioral techniques, some kind of systemic, humanistic therapy, etc. The theoretical orientation of the therapy will depend on the characteristics, needs and preferences of the patient.

On the other hand, they have also been used anxiolytics I antidepressants complementary to psychological intervention, but these should always be considered as specific and support "tools".

Other somatoform disorders

In addition to pain disorder, in the DSM-IV-TR we find other disorders belonging to the same category of somatoform disorders.

These are: the somatization disorder (which also disappears in DSM-5), undifferentiated somatoform disorder, hypochondria (which in the DSM-5 becomes a more comprehensive category, “Illness Anxiety Disorder”), the body dysmorphic disorder (which in the DSM-5 becomes part of obsessive-compulsive disorders) and conversion disorder.

The latter can be of four types: with symptoms or motor deficits, with crises and convulsions, with symptoms or sensory deficits, and mixed presentation.

In addition, within somatoform disorders we also find unspecified somatoform disorder (different from undifferentiated somatoform disorder).

Bibliographic references:

• American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.

• American Psychiatric Association –APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.

• Belloch, A., Sandin, B. and Ramos, F. (Eds.) (1995). Manual of Psychopathology (2 vols.). Madrid: McGraw Hill.

• WHO (2000). ICD-10. International classification of diseases, tenth edition. Madrid. Pan American.