Vit is one of the several somatoform

disorders.

VThe term ´somatoformµ means that

symptoms are physical but not entirely
understood as a consequence of a
general condition.
V2ain is one or more anatomical sites is
the predominant complaint and is
severe enough to require medical or
therapeutic intervention.

V2ain disorder is classified as a mental

disorder because psychological factors
play an important role in the onset,
severity, worsening or maintenance of
pain.
Váarlier names for this disorder include
psychogenic pain disorder and
somatoform pain disorder.

VCommon sites of pain includes the back

(lower back), the head, abdomen, and
chest.
!our domains of interest:
VThe underlying organic problem or
medical condition.
VThe experience of pain.
V!unctional impairment and disability.
Vámotional distress
˜x vary depending on the site of pain and
treated medically.
Vnegative or distorted cognitions
VInactivity, passivity, and or disability
VIncreased pain requiring clinical
interventions
Vinsomnia and fatigue
Vdisrupted social relationships at work,
home or school
Vdepression or anxiety
 psychiatrist or mental health professional
arrives at the diagnosis pain disorder
after considering several questions.
VIf the psychiatrist believes the patient is
pretending to be in pain, the patient is
diagnosed as malingering for external
rewards, such as seeking mood-altering
drugs or as having a factitious disorder
that reflects the patient·s need to adopt
a sick role.
There are several condition that rule out a
diagnosis of pain disorder:
VDyspareunia
V˜omatization disorder
VConversion disorder
VMood, anxiety or psychotic disorder

!inal consideration is whether the pain is

acute or chronic.
VDepending on whether the pain is acute
or chronic, management may involve
one or more of the following:
pharmacological treatment
(medication); psychotherapy (individual
or group); family, behavioral, physical,
hypnosis and/or occupational therapy.
Cont. treatments
VTricyclic antidepressants (TCs) reduce
pain, improve sleep and strengthen the
effects of opioids as well as moderate
depression.
V2ain and depression diminish the
restorative quality of sleep. When the
cycle of pain, depression, insomnia and
fatigue is established, it tends to be self-
perpetuating. Treatment may include
antidepressants, relaxation training, and
education regarding good sleep
hygiene.
The goal of CBT is to restore a sense of self
efficacy by educating the patient about
the pain-tension cycle.
˜ome tension-reducing techniques
includes progressive muscle relaxation,
visual imagery, hypnosis, and
biofeedback.
V2ain diaries are useful for describing
daily patterns of pain and for helping the
patient identify activities, emotions and
thoughts that alleviates or worsen pain,
they are also use in evaluating the
effectiveness of medication given.
VThe cognitive aspect of CBT is based on
cognitive-social learning theory.
The principles of operant conditioning are
taught to the patient and family
members so that activities and non- pain
behaviors are reinforced or encouraged.
The goal is to eliminate pain behaviors
such as passivity, inactivity and over
reliance to pain medications.
Vcupuncture
VTranscutaneous electrical nerve
stimulation (Tá ˜)
VTriggerpoint injections
VMassage
V erve block
VMeditation
Váxercise
VYoga
VMusic and art therapy
V2ain Disorder may be prevented by
early interventions at the onset or in
the early stages of recurring pain.
VContact primary care physicians who
refers you to mental health
professional or pain clinic.