6 - Assessment of pain and psychiatric comorbidities  pp. 82-93

Assessment of pain and psychiatric comorbidities

By Jon Streltzer

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Overview

A condition that fits perfectly within the biopsychosocial model is pain. This applies to all clinical pain states: acute, cancer, and non-cancer chronic pain. Psychosocial and sociocultural factors are part and parcel of pain states, with personal, situational, and cultural factors all influencing the pain experience. The type of medical condition causing the pain state, and its meaning to the individual can also profoundly influence the pain experience and the associated degree of suffering. That being understood, however, pain states are also often comorbid with defined psychiatric disorders. In the case of chronic pain conditions, comorbid psychiatric disorders are particularly important to recognize and incorporate into treatment plans. Patients with cancer pain and terminal pain may also be prone to certain mental disorders, such as depression and delirium. In general, however, psychiatric comorbidity with cancer pain has more to do with the meaning of cancer than with pain.

Current understanding of the etiology and knowledge about effective treatments are strongest for acute pain disorders, but it is chronic pain populations that are of particular interest to psychiatrists, for it is this population that is likely to be the most troublesome to assess and treat. Several mental disorders are found to be more common in chronic pain populations, and the prevalence of mental disorders overall is substantially higher.

Mental disorders are common in pain populations. With regard to acute pain, most mental disorders are probably present in similar proportions to the general population.

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