Pain
DisorderIn this disorder there is pain in the area of a clinical condition.
It leads to the impression of the clinician that the pain is out of proportion
with regard to the clinical findings. The following factors are characteristic
for pain disorders: - pain is the main focus on clinical presentation -
psychological factors are thought to play a major role - pain causes significant
distress with impairment in several areas of functioning (social, work, other
important areas of functioning) - frequent use of the health care system
and significant absenteeism - pain becomes major focus in patient's life
- overuse of pain medication and anxiolytic medication - disruption of
family life (marital problems, dysfunctional behavior). Pain is acute
when it has lasted less than 6 months and pain is chronic when
it lasts longer than 6 months. There is an increase of suicide risk in cancer
patients who have pain and tend to get depressed at the same time. Other mental
illnesses are associated with chronic pain such as mood disorders and anxiety
disorders. Often there is a significant insomnia(=problem to fall asleep and to
sleep through) associated with a pain disorder.
Common
medical conditions associated with pain disorder A
disc herniation in the lower back is a common cause for chronic pain. In the beginning
of this condition everything may point to the disc herniation , which was depicted
on the MRI or CT scan to be the cause of the pain disorder. However, when
the surgery has been done, the pain should be considerably better. But with a
pain disorder the condition may be unchanged. Often the physician associates the
images on tests with the clinical presentation, but the findings may only be coincidental.
Unfortunately this becomes only apparent after the surgery or procedure has been
done and then it is too late as the pain disorder has already developed. A
diabetic neuropathy leads to a painful condition where the nerves to the skin,
muscles and bones in the feet or hands of a diabetic patient are not getting enough
oxygen and nutrients and this leads to chronic severe pain. Postherpetic neuralgia
after a local infection with the chickenpox virus can, particularly in the face,
lead to chronic pain. There are many other conditions that are associated with
pain and all of them can feel a lot worse with an associated pain disorder. Statistics
and course of pain disorder: The occurrence of pain disorder is
high in the U.S. with 10% to 15% of Americans being off work with back pain alone,
let alone other pain conditions(Ref.2). Despite this the majority of pain
disorder are the acute type, which resolves quickly. However, the chronic type
tends to be of many years duration. Statistically first degree relatives of patients
with chronic pain disorder may have a higher likelihood of having depressive disorders,
chronic pain and alcohol dependence.
Therapy
of pain disorder: It will depend on the chronic type pain
disorder whether the patients participate in work and other regular activities
of daily life thereby resisting to let the pain be a determining factor in their
lives. Any therapy such as a chronic pain management group therapy will stress
that the patient be as active as possible and adopt a more positive outlook. Behavioral
therapy and cognitive therapy are also useful. Some of the chronic pain patients
may have to be maintained on antidepressant therapy and low dose long-acting morphine
therapy. There is a trend of using gabapentin
(brand name: Neurontin) in addition with other medications in order
to cut down on the amount of narcotics needed and to improve the quality of life.
The gabapentin link explains how this pain modifier is used in treating pain from
nerve damage in patients with end stage diabetes. Read more
on pain disorder here. |
