Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
Currently Skimming:
9. Psychiatric Aspects of Chronic Pain
9. Psychiatric Aspects of Chronic Pain
Pages 165-186
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 165... ...
Just as there is diversity among chronic pain patients in general, so, too, are individuals with chronic pain and psychiatric disorders a heterogeneous group: many have affective disorders (particularly depression) ; others super from substance abuse, personality disorders, and various somatoform disorders such as conversion, hypochondriasis, and somatization disorder (not to be confused with "somatization" as a normal process, as discussed in Chapter 81.
|
From page 166... ...
Anxiety and somatoform disorders are even more common. Several studies from the ECA project show that individuals with affective disorders seek medical care more often than individuals without psychiatric disorders, they often seek care for medical or somatic symptoms (including pain)
|
From page 167... ...
Studies have reported widely varying prevalence of both depressive symptoms and diagnosable depression in pain patients (1~87 percent) , as well as widely varying prevalence of pain symptoms in clinically depressed patients (27-100 percent)
|
From page 168... ...
Several specific syndromes are ciassified as somatoform disorders, including hypochondriasis, conversion disorder, psychogenic pain disorder, and somatization disorder. Unlike malingering, the symptom production in somatoform disorders is not under voluntary control.
|
From page 169... ...
Usually the affected person repeatedly seeks medical care (American Psychiatric Association, 19801. Many chronic pain patients involved in the disability process have traits of this disorder without meeting the full DSM-Ill criteria.
|
From page 170... ...
For example, at the University of California at Davis, 20 percent of men and 32 percent of women with chronic pain were diagnosed with psychogenic pain disorder (Reich et al., 19831. However, at the University of Miami, where 85 percent of pain patients were given an "organic treatment diagnosis" of myofascial pain syndrome, none of the women and only 0.6 percent of the men were classified as having psychogenic pain disorder (Fishbain et al., 19861.
|
From page 171... ...
They represent a group of empirically derived diagnoses with somewhat arbitrary symptoms, they are not theoretically based, and they all assume that a thorough and adequate physical examination has ruled out organic disease or anatomical abnormalities that would account for the symptomatology. Furthermore, clinical experience with chronic pain patients suggests that the diagnoses are not very useful or appropriate.
|
From page 172... ...
PeIz and Merskey (1982) demonstrated that for some chronic pain patients there are long-term psychological effects, including depression, and that the rates and nature of these effects are not different in patients either receiving or not receiving disability payments.
|
From page 173... ...
Vigilance about drug dependence, adverse side effects, and prolonged withdrawal syndromes is a well-established practice in the prescription of opiates and barbiturates but is much less so with other classes of drugs used with pain patients. For example, many people in pain have a very Biscuit time sleeping and greatly overuse nighttime sedative-hypnotic drugs.
|
From page 174... ...
hnipramine was superior to placebo treatment, and all three treatments were superior to 'Youtine clinical management." While hnipramine worked faster than the psychotherapeutic modalities to relieve depressive symptoms, ultimately all three modalities achieved similar results (Elkin et al., 1986~. Interpersonal therapy is based on a model postulating that depression results from difficulties in interpersonal relationships.
|
From page 175... ...
The task of cognitive therapy is to identify these faulty cognitions, to enable the patient to recognize that the thoughts are mistaken, and to substitute alternative cognitive structures that can lead to improved affective and behavioral responses. In combination with behavioral therapies, cognitive therapy has been found useful in the treatment of chronic pain patients (Turner, 1982; Turner and Chapman, 1982~.
|
From page 176... ...
For example, anxiolytic drugs, particularly benzodiazepines, are used adjunctively in the management of many medical and psychiatric disorders in which anxiety is prominent. There is little controlled evidence to support their efficacy in treating pain conditions, except for short-term muscle relaxation.
|
From page 177... ...
. Low back pain patients, particularly men, are often found to have higher rates of alcoholism than control populations; and disabled low back pain patients have higher rates than nondisabled patients.
|
From page 178... ...
Yet as is true of the relation between other psychological and psychiatric factors discussed in this chapter and elsewhere in this volume, the nature of the association is not well understood. The extent to which welldefined personality factors in chronic pain patients precede the development of symptoms or are highlighted and amplified by pain and reflect learned behaviors remains unclear.
|
From page 179... ...
Again, these data do not identify whether the personality factors antedate or result from the pain experience. On the basis of a comprehensive literature review of the use of psychological tests with chronic back pain patients, Southwick and White (1983)
|
From page 180... ...
has suggested that traditional psychotherapeutic techniques have considerable utility in the treatment of chronic pain patients. These techniques may be particularly helpful in breaking the cycle, so often seen for help-rejecting patients, of clinicians becoming increasingly frustrated and angry and ultimately rejecting the patient because of the patient's failure to improve.
|
From page 181... ...
Studies of depression in pain patients are often further confounded by imprecision in diagnosis (including inadequate distinctions between symptoms and disorder) and by sampling bias.
|
From page 182... ...
Male and female chronic pain patients categorized by DSM-lII psychiatric diagnostic criteria.
|
From page 183... ...
K~merow, D.B., Pincus, H.A., and MacDonald, D.I. Alcohol abuse, other drug abuse and mental disorders in medical practice: prevalence, costs, recognition and treatment.
|
From page 184... ...
Reich, J., Tupin, J.P., and Abramowitz, S.I. Psychiatric diagnosis of chronic pain patients.
|
From page 185... ...
American Journal of Medicine 75(5A)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.