Pain Disorder

The IASP (International Association for the Study of Pain) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage …”. Unlike acute pain that serves as a “fifth vital sign” to warn of an injury or a disease, chronic or persistent pain has no purpose. There is no collective agreement on the definition of chronic pain but it commonly refers to pain that serves no biological value, lasts longer than the usual healing time, has no or minimal response to specific treatments or remedies, and is of a duration greater than 6 months.

Chronic pain can be severe and may bring about psychological distress, job loss, social isolation, and is highly comorbid with depression and anxiety. Additionally, in a general hospital setting, many medically unexplained pains can now be better understood to involve an interplay between neurophysiological mechanisms and psychological factors that may have gone awry.

SSD or Somatic Symptoms Disorder is a single diagnostic entity that has now replaced Pain Disorder, previously found in the DSM-IV (Diagnostic and Statistical Manual, 4th edition) somatoform disorders category where other diagnoses such as somatization disorder, undifferentiated somatoform disorder, hypochondriasis are grouped.

Psychological dysfunction has been attributed to various descriptions of pain such as phantom limb pain, dyspareunia, orofacial pain, fibromyalgia, pelvic pain, and many others more, including abdominal pain, chest pain, and headache. Pain that has no anatomical distribution; the sensation of pain in non-injured territories; pain that appears out of proportion to the degree of injury; and also pain in the absence of injury have been described as symptoms. Assessors would need to consider any psychological disturbances that underlie each of the pain symptom.

Getting help is important to improve symptoms and restore function to daily living. Treatment choices include psychotherapy such as cognitive behaviour therapy (CBT) or family therapy, appropriate antidepressant therapy and adequate pain management. CBT is recommended to address the added element of health anxiety and depression associated with chronic pain, as it teaches coping to tackle stress, shape beliefs and expectations about health. Specific antidepressants can alleviate pain symptoms and manage mood and anxiety symptoms.