Pain Disorder
By Dr. David Gyepes, Ph.D., JD, QME
Pain Disorder as a psychiatric condition is diagnosed when a patient's preoccupation with pain is consuming and to some extent disabling. The pain becomes the dominating focus of their clinical presentation. The pain itself causes clinically significant dis-stress or impairment.
Pain Disorder is a psychiatric disorder that is a form of somatoform disorder. In somatoform disorders such as Somatization Disorder, Conversion Disorder, Hypochondriasis and Pain Disorder, the subject complains of symptoms which are excessive, or for which there is no demonstrable, organic basis and there is a tendency to physically experience emotional distress.
Unlike malingering, the production of symptoms in somatoform disorders is unconscious and unintentional - the person is not simulating or feigning illness, but fully believes that the illness is real. In malingering, symptoms are fabricated to achieve an overt and tangible goal, such as to seek compensation, or evade work.
Secondary symptom production is fully conscious and intentional with obvious secondary gain; the symptoms disappear when they are no longer practical or useful. In practice, it is not always easy to definitively distinguish among these conditions and in fact many patients may show overlapping presentations, suggesting that the conditions should not be thought about as mutually exclusive.
The DSM-IV TR defines Pain Disorder as:
1) Pain in one or more anatomical sites and is the predominant focus of the clinical presentation. It is of sufficient severity to warrant clinical attention.
2) The pain causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
3) Psychological factors are judged to have an important role in onset, severity, exacerbation or maintenance of the pain.