Three Types of Pain Disorders DSM-IV Distinguishes

1. Pain associated with impaired psychological factors. Psychological factors are considered as the main cause, degree, exacerbation, or maintenance of the pain. In case of any medical condition that does not care much for the beginning, severity, exacerbation, or maintenance of the pain.
2. Pain disorder associated with both psychological factors such as medical conditions. Both psychological and physical factors play an important role in the beginning, severity, exacerbation, or maintenance of the pain.
3. Disorder pain associated with medical illness factors. Pain disorder is mainly due to physical causes of onset, degree, exacerbation and maintenance of pain, although psychological factors here - but not dominant component accompanying - there may be. This man is not one of mental disorders.

Pain disorder follows the type of course is divided into acute (lasting less than six months) or chronic (lasting six months or more). If the criteria for somatization disorder are met, there is no somatoform pain disorder is diagnosed. If the pain is self-contained, pain disorder can be diagnosed next to depression or anxiety.

According to DSM-IV, one can define the following pain disorders:

As the main focus, there are certain pain clinical relevance in one or more areas of the body.

The pain causes clinically significant distress and disability in social, occupational, or other areas of life.

Psychological factors play an important role in the development, strengthening and maintenance of pain.

Pain and related disability does not artificially cause (secret self abuse) or simulation.

The pain can not be explained adequately by certain mental disorders (depression, anxiety disorders, schizophrenia, stress or substance withdrawal, dyspareunia, other somatoform disorders such as somatization or neurasthenia) (However, comorbidities that can be given).

The difference between pain disorders with psychological dominant factor (without requiring them to be regarded as a mono-causal cause pain interference with organic and psychological factors and pain interference with mainly organic factors play no, or only a minimal role in the psychological aspect.

The difference between acute pain disorders with a duration of less than six months program and chronic pain disorder with a history that lasted more than six months.

The definition of pain disorder according to DSM-IV correspond more to the modern understanding of pain as the description in accordance with the guidelines for ICD-10 clinical diagnostic them. However, the DSM-IV-discrimination in two psychiatrically relevant subtypes depending on the degree of pain interference physical findings problematic. It is almost impossible in practice and diagnostic interviews to accurately distinguish between physical and psychological components of pain interference from each other. A clear difference between the two subgroups (pain with or without a medical condition) would require any safety could assess the relevance of a herniated disc for the current pain level as the investigator. The difference between the two disorders are a pain to psychiatric differential diagnosis is usually not important. MR studies showed that even in people without pain often consists of abnormalities in the spine. Aigner and Bach has been demonstrated at the end of 1990 in patients with chronic pain in Vienna that patients in both groups did not differ on psychosocial variables (age, gender, education), Somatisierungsbeschwerden level and frequency of depressive disorders.

DSM-IV lists the typical problems resulting from the interruption of pain: time off from work or school, long hours sick leave, unemployment, early retirement, excessive drug use, abuse of sedatives or painkillers, often using medical facilities, social withdrawal , partner problems, limitations of activity to the point of complete active, reducing physical activity, state of depression, high costs for all schools or alternative medical treatments in the hope of healing.

Distinguished in the diagnosis of somatoform pain disorder should be between emotional stress and psychosocial triggers and only secondarily due to mental health problems of disease.

Biographical history is the most important way to detect somatoform pain disorder and allows in 80-90% of cases the difference of the pain associated with major organs. Many patients experience physical violence and / or sexual abuse or neglect as a child's fundamental in their lives. In women with sexual abuse in childhood experiences, lowered pain threshold, so often persistent pain in the stomach occurs.

As a diagnostic indicator of somatoform pain disorder following aspects considered by psychoanalytic experts nickel and Egle:

The onset of symptoms before age 35.

Somatoform pain is described as less typical and often quite obvious in comparison with organic pain.

In most cases, a high pain intensity is given without free interval.

Patients often describe their pain with mood adjectives such as "terrible", "horrible" or "terrible".

Location and modalities of pain can be changed. The most commonly affected are the extremities, face and stomach.

The limits of sensory anatomy of supply are not met (for example, when the pain of facial midline to the opposite side or the border of the mandible to the neck, the "disc pain" radicular character).