Psychiatry and Pain
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- Mental health problems are very common. More than 1 in 2 New Zealanders will suffer from a psychiatric problem in their life-time.
- Chronic Pain and mental health problems are closely interlinked
- Psychiatric Diagnosis is currently made using the DSM IV classification
- Axis I = Clinical Disorders
- Axis II = Personality Disorders
- Axis III = General Medical Conditions
- Axis IV = Psychosocial and Environmental Problems
- Axis V = Global Assessment of Functioning
- Pain of clinical severity
- Pain causes distress or impairment
- Psychological factors involved
- Not factitious or malingered
- Mood, anxiety, psychotic disorders & dyspareunia excluded
- Pain disorder associated with psychological factors
- Pain Disorder associated with both psychological factors and a general medical condition
- Pain disorder associated with a general medical condition
Epidemiology of mental health problems amongst pain patients
Bob Large, Consultant Psychiatrist. The Auckland Regional Pain Service reported the following mental health issues in 172 chronic pain patients in 1980.
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- Large B. Psychiatric Disorder. Pain 1980, 9:253-263
- Manchikanti L, Fellows B, Pampati VS, Damron KS, Beyer CD, Barnhill RC. Comparison of psychological status of chronic pain patients with general population. Pain Physician 2002; 5:40-48.
- Manchikanti L, Pampati VS, Damron KS, Beyer CD, Barnhill RC. Evaluation of psychological status in chronic low back pain: Comparison with general population. Pain Physician 2002; 5:149-155.
- McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 2003; 106:127-133. [pubmed]
- Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low back pain: The mind and the spine – which goes first? Spine 1993; 18:66-71.