Introduction
With pain disorder there is pain in the area of a clinical condition. It leads to the impression of the clinician that the pain is out of proportion with regard to the clinical findings.
The following factors are characteristic for pain disorders:
– pain is the main focus on clinical presentation
– psychological factors are thought to play a major role
– pain causes significant distress with impairment in several areas of functioning (social, work, other important areas of functioning)
– frequent use of the health care system and significant absenteeism
– pain becomes major focus in patient’s life – overuse of pain medication and anxiolytic medication
– disruption of family life (marital problems, dysfunctional behavior).
Pain is acute when it has lasted less than 6 months and pain is chronic when it lasts longer than 6 months. There is an increase of suicide risk in cancer patients who have pain and tend to get depressed at the same time. Other mental illnesses are associated with chronic pain such as mood disorders and anxiety disorders. Often there is a significant insomnia(=problem to fall asleep and to sleep through) associated with a pain disorder.
Common medical conditions associated with pain disorder
A disc herniation in the lower back is a common cause for chronic pain. In the beginning of this condition everything may point to the disc herniation , which was depicted on the MRI or CT scan to be the cause of the pain disorder.
However, when the surgery has been done, the pain should be considerably better. But with a pain disorder the condition may be unchanged. Often the physician associates the images on tests with the clinical presentation, but the findings may only be coincidental. Unfortunately this becomes only apparent after the surgery or procedure has been done and then it is too late as the pain disorder has already developed.
A diabetic neuropathy leads to a painful condition where the nerves to the skin, muscles and bones in the feet or hands of a diabetic patient are not getting enough oxygen and nutrients and this leads to chronic severe pain. Postherpetic neuralgia after a local infection with the chickenpox virus can, particularly in the face, lead to chronic pain. There are many other conditions that are associated with pain and all of them can feel a lot worse with an associated pain disorder.
Pain Disorder
Statistics and course of pain disorder
The occurrence of pain disorder is high in the U.S. with 10% to 15% of Americans being off work with back pain alone, let alone other pain conditions (Ref.2).
Despite this the majority of pain disorder are the acute type, which resolves quickly. However, the chronic type tends to be of many years duration. Statistically first degree relatives of patients with chronic pain disorder may have a higher likelihood of having depressive disorders, chronic pain and alcohol dependence.
Therapy of pain disorder
It will depend on the chronic type pain disorder whether the patients participate in work and other regular activities of daily life thereby resisting to let the pain be a determining factor in their lives. Any therapy such as a chronic pain management group therapy will stress that the patient be as active as possible and adopt a more positive outlook. Behavioral therapy and cognitive therapy are also useful. Some of the chronic pain patients may have to be maintained on antidepressant therapy and low dose long-acting morphine therapy. There is a trend of using gabapentin (brand name: Neurontin, thanks to en.wikipedia.orgfor this link) in addition with other medications in order to cut down on the amount of narcotics needed and to improve the quality of life. The gabapentin link explains how this pain modifier is used in treating pain from nerve damage in patients with end stage diabetes.
References:
1. Dr. David Burns: “Feeling good –The new mood therapy”, Avon Books, New York,1992.
2. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV),American Psychiatric Association, Washington,DC,1994.
3. Dr. Shaila Misri at the 46th St. Paul’s Hosp. Cont. Educ. Conference, November 2000, Vancouver/B.C./ Canada.
4. JM Loftis et al. J Neurochem 2000 Nov 75(5): 2040-2050.
5. B. Zilbergeld et al. “Hypnosis – Questions& Answers”, W.W. Norton & Co, New York,1986: 307-312.
6. MH Erickson & EL Rossi:”Hypnotherapy, an exploratory casebook”, Irvington Publishers Inc., New York, 1979: chapter 8, 314-363.
7. G Steketee et al. Compr Psychiatry 2001 Jan 42(1): 76-86.
8. DS Mennin et al. J Anxiety Disord 2000 July-Aug 14(4): 325- 343.
9. J Hartland: “Medical &Dental Hypnosis and its Clinical Applications”, 2nd edition, Bailliere Tindall,London,1982, page: 326-336.
