Pain disorder is chronic pain experienced by a patient in one or more areas and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age and occurs more frequently in girls than boys. This disorder often occurs after an accident, during an illness that has caused pain, or after withdrawing from use during drug addiction, which then takes on a 'life' of its own.
Signs and symptoms Common side effects or comorbidities of pain disorder include depression, anxiety, inactivity, disability, sleep disturbance, fatigue, and disruption of social relationships. Pain conditions are generally considered "acute" if they last less than six months and "chronic" if they last six or more months. The neurological or physiological basis for chronic pain disorders is currently unknown; they are not explained by, for example, clinically obtainable evidence of disease or of damage to the painful areas. In many cases, pain levels can vary depending on circumstances and can often be moderated to some extent by activity and mood. For example, pain symptoms may become more intense when focused on and less intense when the person is engaged in enjoyable activities. The same can be said about excessive worry. A minor physical symptom can be aggravated or become more harmful and threatening if the affected person engages in a constant body and symptom appraisal, which can lead to stress and maladaptive behavior when coping with the physical symptom.
Cause
There are several theories regarding the causes of pain disorder.
Psychodynamic theory: unconscious conflicts or desires are converted into somatic symptoms to protect the person from conscious awareness of it. Emotions and communication: Children show distress in what may be the only way they can, as well as physical symptoms when they lack the ability to speak or express their thoughts. Social influences: where psychological disorders are frowned upon, whether in families or cultures, distress may be expressed in physical terms. Learning theory: children learn to imitate a family member or pick up on possible gains of being "sick". Family systems theory: a child's role in a family may be the sick one as part of the family dynamics. Reasons why fall under four possibilities: enmeshment, overprotection, rigidity or lack of conflict resolution. Trauma and abuse: this includes physical, psychological, or both combined with somatization. It is a common combination. People who have a history of physical or sexual abuse are more likely to have this disorder. However, not every person with pain disorder has a history of abuse. Early intervention when pain first occurs or begins to become chronic offers the best opportunity for the prevention of pain disorder.
Diagnosis The DSM-IV-TR specifies three coded subdiagnoses: pain disorder associated with psychological factors, pain disorder associated with both psychological factors and a general medical condition and pain disorder associated with a general medical condition (although the latter subtype is not considered a mental disorder and is coded separately within the DSM-IV-TR). Conditions such as dyspareunia, somatization disorder, conversion disorder, or mood disorders can eliminate pain disorder as a diagnosis. Diagnosis depends on the ability of physicians to explain the symptoms and on psychological influences. There are, however, authors who propose that the diagnosis for unexplained pain should be adjustment disorder because it does not pathologize individuals with this medical condition. This is proposed to avoid the stigma of such illness classification.
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