Somatoform Disorders

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Pain disorder

Pain is the

most frequent complaint in medical practice and intractable pain syndromes are common.

Epidemiology: It is diagnosed twice as frequently in women as in men. Peak

age of onset is in the 4th or 5th decade. It is more common in blue-collar occupations probably because of increased likelihood of job-related injuries.

Etiology

Psychological

: An intrapsychic conflict is expressed through pain. They are unable to articulate their feelings in words and therefore their bodies express their feelings.

Behavioral : Pain behaviors are reinforced when rewarded and inhibited when ignored or punished.

Interpersonal factors : Intractable pain may be used as a means of manipulation and gaining advantage in interpersonal relationships.

Biologic factors : Cerebral cortex can inhibit the firing of afferent pain fibres. Serotonin and endorphins play a role in the central nervous system modulation of pain.

Clinical features : Patients with pain disorder form a heterogenous collections of people with lowback pain, headache, atypical facial pain, chronic pelvic pain etc. A psychological factor is significantly involved in the pain symptoms and their ramifications. They have long histories of medical and surgical care. They insist on many medications and surgery. They deny any source of psychosocial stress. Substance dependence, anxiety and depression may be found in association with pain disorder.

Types :

  • Pain disorder associated with psycho logical factors

  • Pain disorder associated with both psychological factors and general medical condition.

  • Pain disorder associated with general medical condition.

Pain disorders are said to be acute if they last for less than 6 months and chronic if the last for more than 6 months.

Differential diagnosis : Must be differentiated from organic medical & neurologic conditions, other forms of somatoform disorders and malingering.

Course : Abrupt onset is usual. They are often chronic, distressful and completely diabling.

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