Pain disorder: what it is, causes, symptoms and treatment.

We analyze what this type of somatoform disorder consists of.

Somatoform disorders involve a series of physical symptoms that cannot be explained by any medical disease. In addition, they have the characteristic that there are a series of underlying psychological factors that are related to their onset, maintenance or exacerbation.

In this article we will learn about one of these disorders: Pain disorder, in which the main symptom is pain.in which the main symptom is an intense and incapacitating pain. We will see its characteristics, types, symptoms, causes and treatments.

Pain disorder: what is it?

Pain disorder is a disorder belonging to the category of "somatoform disorders" of the DSM-IV-TR (APA, 2002). In the DSM-5 (APA, 2013), this category is renamed "somatic symptom and related disorders".

In addition, an important change to note is that pain disorder disappears as such in this new edition of the DSMand becomes a specifier of somatic disorders.

Let's see what somatoform (or somatoform) disorders are, such as pain disorder.

Somatoform disorders

The somatoform or somatoform disorders encompasses a group of mental disorders characterized by the appearance of a series of physical symptoms that are not explained by any medical condition; however, these symptoms are related to a medical condition.However, these symptoms are related to psychological factors, such as traumatic events.

It is important to differentiate somatoform disorders, such as pain disorder, from psychosomatic disorders or diseases. The latter are known and specific organic pathologies or pathophysiological processes, where psychological and psychosocial factors are related to their onset or course.

Characteristics

Pain disorder, which is listed as a diagnosis in the DSM-IV-TR, was formerly called "somatoform pain". It was also called "chronic pain", a term first used by Keefe in 1982.

As for its epidemiology, pain disorder is the most prevalent of all somatoform disorders in the clinical setting.. It occurs more frequently in women than in men, mainly as symptomatology related to menstrual pain.

Symptoms

Let us look at the main symptoms of pain disorder, which in turn correspond to its diagnostic criteria.

1. Pain

As the name suggests, the main symptom of pain disorder is localized pain in one or more areas of the body.. This pain is severe enough to require specific clinical attention.

2. Discomfort

Such pain causes significant discomfort in the patient.. This discomfort can also lead to a deterioration in the person's life, and is clinically relevant. That is to say, it is significant and is not reduced to a simple sensation of discomfort.

3. Psychological factors

In addition, pain disorder is associated with a number of psychological factors, pain disorder is associated with a series of psychological factors that play a determining role in the pain itself, i.e., these factors have an influence on the pain itself.that is to say, these factors have an important influence on the onset, course, maintenance or worsening of the pain symptom.

It is worth mentioning that when pain appears associated with a medical illness, this could not be considered a mental disorder.

4. There is no simulation

Finally, the patient does not simulate this pain in any way, nor does he/she produce it intentionally.nor does he/she produce it intentionally. This characteristic would differentiate it from simulation.

Types

In the DSM-IV-TR it is necessary to code the type of pain disorder manifested by the patient, which can be of two types.

1. Pain disorder associated with psychological factors

In this case, there are a series of psychological factors (e.g. anxiety experienced by stressful life events, traumatic experiences, nervousness, etc.) that explain why the pain symptom started, why it was exacerbated or why it is maintained over time.

In other words, these factors play a relevant role in the onset, maintenance and/or worsening of pain.

Pain disorder associated with psychological factors and medical illness.

In this second type of pain disorder, in addition to the aforementioned psychological factors, there is also an underlying medical disease; although, we emphasize, these psychological factors must always exist, necessarily.

This subtype is more frequent than the previous one.

Specifiers

On the other hand, in the DSM-IV-TR it is also necessary to specify whether the pain disorder is acute or chronic.

Acute

Acute pain disorder has a duration of less than 6 months.

2. Chronic

In the case of a diagnosis of chronic pain disorder, the duration is equal to or longer than 6 months.

It should be noted that in the WHO classification (ICD-10, International Classification of Diseases), there is also a diagnosis of pain disorder, and that in this classification the persistence of the pain symptom is at least 6 months (a requirement that the DSM-IV-TR does not have).

Causes

The causes of pain disorder, as we have seen, are associated exclusively with psychological factors (which are usually stressful for the person), or with psychological factors together with some type of medical illness suffered by the patient. Psychological factors include stressful or traumatic events for the patient, a fast pace of life that causes anxiety, poorly managed grief, the death of a loved one, etc.

But, let us remember, the pain of pain disorder can never be explained exclusively by a medical conditionbecause then we would not be talking about this diagnosis or a mental disorder.

Treatment

The treatment of pain disorder will include a psychological intervention aimed at treating the underlying causes of the pain disorder.In this case, the psychological factors that explain the pain symptomatology. So the therapy must be personalized for each patient and adapted to each specific case, since the factors will always vary from one case to another.

Cognitive-behavioral techniques, some type of systemic therapy, humanistic, etc. can be used. The theoretical orientation of the therapy will depend on the characteristics, needs and preferences of the patient.

On the other hand, anxiolytics and/or antidepressants have also been used in addition to psychological intervention, but these should always be considered as punctual and supportive "tools".

Other somatoform disorders

In addition to pain disorder, in the DSM-IV-TR we find other disorders belonging to the same category of somatoform disorders.

These are: somatization disorder (which also disappears in DSM-5), undifferentiated somatoform disorder, hypochondriasis (which in DSM-5 becomes a more global category, "illness anxiety disorder"), body dysmorphic disorder (which in DSM-5 becomes part of obsessive-compulsive disorders) and conversion disorder.

The latter can be of four types: with motor symptoms or deficits, with seizures and convulsions, with sensory symptoms or deficits, and with mixed presentation.

In addition, within somatoform disorders we also find somatoform disorder not otherwise specified (different from undifferentiated somatoform disorder).

Bibliographic references:

• American Psychiatric Association (APA). (2002). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Barcelona: Masson.

• American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and statistical manual of mental disorders. Madrid: Panamericana.

• Belloch, A., Sandín, B. and Ramos, F. (Eds.) (1995). Manual de Psicopatología (2 vols.). Madrid: McGraw Hill.

• WHO (2000). ICD-10. International classification of diseases, tenth edition. Madrid. Panamericana.