CHAPTER 8 - Chronic Pain

Abstract

Pain is synonymous with a threat to life. The situation is quite different with chronic pain where the pain no longer serves a warning function. Chronic pain, regardless of etiology, becomes a burden to be borne by the sufferer. Individuals with chronic pain commonly seek out medical assistance with the expectation of relieving their suffering. This chapter reviews the problem of chronic pain from a psychiatric perspective. This includes a consideration of the diagnostic approach to the chronic pain patient where the phenomenon of chronic pain is considered from a psychodynamic and psychobiologic viewpoint. The chapter discusses the consideration of psychiatric approaches to treatment with an emphasis on the pharmacologic approaches to chronic pain management. It reviews conversions and psychogenic pain disorders, and somatoform disorders. One of the frequent observations in the series of studies on conversions and psychogenic pain disorders is the occurrence of clinical depression among patients diagnosed as having psychogenic pain or conversional disorders. The chapter also reviews the interesting correlation between depressive disorder and chronic conversion or psychogenic pain disorder. It further presents acute and chronic forms of conversion or psychogenic pain disorders.