Pain disorder

Pain disorder is chronic pain experienced by a patient in one or more areas and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.

Common side effects or comorbidities of pain disorder include depression, anxiety, inactivity, disability, sleep disturbance, fatigue, and disruption of social relationships. Pain conditions are generally considered "acute" if they last less than six months and "chronic" if they last six or more months. The neurological or physiological basis for chronic pain disorders is currently unknown; they are not explained by, for example, clinically obtainable evidence of disease or of damage to the painful areas.^{[citation needed]}

In many cases, pain levels can vary depending on circumstances and can often be moderated to some extent by activity and mood. For example, pain symptoms may become more intense when focused on and less intense when the person is engaged in enjoyable activities. The same can be said about excessive worry. A minor physical symptom can be aggravated or become more harmful and threatening if the affected person engages in a constant body and symptom appraisal, which can lead to stress and maladaptive behavior when coping with the physical symptom.

There are several theories regarding the causes of pain disorder.

The DSM-IV-TR specifies three coded subdiagnoses: pain disorder associated with psychological factors, pain disorder associated with both psychological factors and a general medical condition and pain disorder associated with a general medical condition (although the latter subtype is not considered a mental disorder and is coded separately within the DSM-IV-TR). Conditions such as dyspareunia, somatization disorder, conversion disorder, or mood disorders can eliminate pain disorder as a diagnosis. Diagnosis depends on the ability of physicians to explain the symptoms and on psychological influences.

There are, however, authors who propose that the diagnosis for unexplained pain should be adjustment disorder because it does not pathologize individuals with this medical condition. This is proposed to avoid the stigma of such illness classification.

The prognosis is worse when there are more areas of pain reported. Treatment may include psychotherapy (with cognitive-behavioral therapy or operant conditioning), medication (often with antidepressants but also with pain medications), and sleep therapy.

According to a study performed at the Miller School of Medicine at the University of Miami, antidepressants have an analgesic effect on patients with pain disorder. In a randomized, placebo-controlled antidepressant treatment study, researchers found that "antidepressants decreased pain intensity in patients with psychogenic pain or somatoform pain disorder significantly more than placebo". Prescription and nonprescription pain medications do not help and can actually hurt if the patient experiences side effects or develops an addiction. Instead, antidepressants and talk therapy are recommended. CBT helps patients learn what worsens the pain, how to cope, and how to function in their life while handling the pain. Antidepressants work against the pain and worry. Unfortunately, many people do not believe the pain "is all in their head," so they refuse such treatments. Other techniques used in the management of chronic pain may also be of use; these include massage, transcutaneous electrical nerve stimulation, trigger point injections, surgical ablation, and non-interventional therapies such as meditation, yoga, and music and art therapy.