Psychogenic Pain Disorder

Pain is the signs and symptoms of a disease. If the pain itself becomes a problem, has been discussed for DSM-III, namely (Called at that time "psychogenic pain disorder") since 1980, from pain disorders.

Persistent somatoform pain disorder (F45.4) is characterized by the clinical diagnostic guidelines for ICD-10 with the following features:

Dominant complaint is persistent pain, severe and excruciating.

The pain is caused by a physiological process or a physical disorder is not fully understood.

The pain occurs in association with emotional conflict or psychosocial problems.

Conflicts and problems should be so severe that they can be regarded as a decisive causal influence.

The pain usually has the care or medical attention or personal results are significant.

According to the ICD-10 research criteria are somatoform pain disorder lasts defined by the following two features [27]:

A. There are at least six months, constantly, constantly in almost every day, heavy and burdensome pain in the body that can not be adequately described by a physiological process or a physical disorder, and attention is directed eternal gravity concerned.

B. The disturbance does not occur exclusively during the period or certain other diseases (schizophrenia or related disorders, affective disorders, somatization disorder, undifferentiated somatization disorder, hypochondriacal disorders).

As the term "related" (synonym) applies in the following designations ICD-10: psychalgia, back psychogenic or somatoform pain disorder headache. Pain due to known or suspected psychophysiological mechanisms, such as muscle tension, pain or migraine that "may psychogenic" according to ICD-10, not part of somatoform pain disorder, but the F54 code ("psychological factors and behavioral factors in other diseases classified elsewhere ") and by using an additional code from other areas of the ICD-10 (eg, migraine G43) to classify.

Tension headache (G44.2), back pain unspecified (M54.9) and unspecified acute or chronic pain (R52) which, according to the ICD-10 guidelines somatoform pain disorder is not constant. Presumably, psychogenic pain during depression or schizophrenia should not be included in the diagnosis as well. The most common pain that psychological factors play a role, which is a lot of headaches and backaches are not considered somatoform pain disorder, but as the pain in which psychological factors and behavioral factors play a role (F54).

Psychophysiological mechanisms such as the functional muscle tension (eg headaches due to muscle contraction) may therefore on somatoform pain disorder is not available, since this is the event of nociceptive pain, even if the tension was initially triggered by psychosocial stress factors.

Criteria of time (at least six months duration) and a continued focus on patient care is required on pain symptoms - in the ICD-10 research criteria - unlike in the clinical diagnostic guidelines. It was decided to criteria serious emotional conflict or psychosocial problems as "determining the causal influence" on the pain, it will throw exclusion criteria for certain mental disorders. Thus, sustained pain other somatoform pain disorder can be calculated if the "inadequate" (according to the guidelines of "complete") can be explained by organic factors.

Published only after the clinical diagnostic criteria of ICD-10 research guidelines - such as the DSM-IV - throw with emotional and conflict assessment of psychosocial factors as important causal influence. The pain may simply can not be explained purely organic. Examiner does not have to leave the problematic assessment, therefore, whether the degree of pain exceeds the expected also in accordance with the degree of physiological findings.