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Psychiatry in chronic pain: A review and update

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Abstract

As the field of pain management nears the halfway point of the Congressionally declared “Decade of Pain Control and Research,” the prevalence of chronic pain and disability related thereto continue to escalate. In the context of rising costs and suffering associated with persistent pain worldwide, the chronic pain research community has increasingly recognized and investigated the role of the cognitive and affective dimensions of pain. In this paper, the authors review psychologic aspects of pain, psychopathology in chronic pain syndromes, suicidality in this population, and the use of psychotropic medications for treatment in these patients. Where possible, the authors have outlined limitations of previous research in these areas, and have highlighted and described recent studies that have addressed these perceived shortcomings. The role of the psychiatrist in the treatment of patients with chronic pain is reviewed.

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References and Recommended Reading

  1. Breuer J, Freud S: Studies on hysteria [1895]. In The Standard Edition of the Complete Psychological Works of Sigmund Freud. Edited by Strachey J. London: Hogarth; 1955:156.

    Google Scholar 

  2. Moskovitz MA: Advances in understanding chronic pain: mechanisms of pain modulation and relationship to treatment. Neurology 2002, 59:S1.

    Google Scholar 

  3. Stewart WF, Ricci JA, Chee E, et al.: Lost productive time and cost due to common pain conditions in the US workforce. J Am Med Assoc 2003, 290:2443–2454.

    Article  CAS  Google Scholar 

  4. Sharp TJ, Harvey AG: Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001, 857–877.

  5. American Pain Foundation: Pain Facts. http://www.painfoundation. org/page.asp?file=Media/painsurveys.htm&menu=1

  6. Hodgkiss A: Rediscovering the psychopathology of chronic pain. J Psychosom Res 1997, 3:221–224.

    Article  Google Scholar 

  7. Keefe FJ, Lumley MA, Buffington AL, et al.: Changing face of pain: evolution of pain research in psychosomatic medicine. Psychosom Med 2002, 64:921–938.

    Article  PubMed  Google Scholar 

  8. Engel GL: "Psychogenic" pain and the pain-prone patient. Am J Med 1959, 26:899–918.

    Article  PubMed  CAS  Google Scholar 

  9. Turk DC, Flor H: Etiological theories and treatment for chronic back pain, II: psychological models and interventions. Pain 1984, 19:209–233.

    Article  PubMed  CAS  Google Scholar 

  10. Campbell LC, Clauw DJ, Keefe FJ: Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003, 54:399–409.

    Article  PubMed  Google Scholar 

  11. Von Korff M, Simon G: The relationship between pain and depression. Br J Psychiatry Suppl 1996, 30:101–108.

    Google Scholar 

  12. Banks S, Kerns R: Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychol Bull 1996, 119:95–110.

    Article  Google Scholar 

  13. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (Text Revision), Fourth Edition. Washington, DC: American Psychiatric Association, 2000.

    Book  Google Scholar 

  14. Cassem EH: Depression and anxiety secondary to medical illness. Psychiatr Clin North Am 1990, 13:597–612.

    PubMed  CAS  Google Scholar 

  15. Endicott J: Measurement of depression in patients with cancer. Cancer 1984, 53:2243–2248.

    PubMed  CAS  Google Scholar 

  16. Wilson KG, Mikail SF, D’Eon JL, et al.: Alternative diagnostic criteria for major depressive disorder in patients with chronic pain. Pain 2001, 91:227–234.

    Article  PubMed  CAS  Google Scholar 

  17. Dersh J, Polatin PB, Gatchel RJ: Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med 2002, 64:773–786. The authors have written a thorough review of the literature on the relationship between various forms of psychopathology with chronic pain syndromes, including an excellent overview of the "chicken-andegg" debate about the relationship of depression and chronic pain.

    Article  PubMed  Google Scholar 

  18. McWilliams LA, Cox BJ, Enns MW: Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 2003:127–133.

  19. Kessler RC, McGonagle KA, Zhao S, et al.: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994, 51:8–19.

    PubMed  CAS  Google Scholar 

  20. Hendin H: Suicide, assisted suicide, and mental illness. J Clin Psychiatry 1999, 60:46–50.

    PubMed  Google Scholar 

  21. Meier DE, Emmons CA, Litke A, et al.: Characteristics of patients requesting and receiving physician-assisted death. Arch Intern Med 2003, 163:1537–1542.

    Article  PubMed  Google Scholar 

  22. Fishbain DA: The association of chronic pain and suicide. Semin Clin Neuropsychiatry 1999, 4:221–227.

    PubMed  CAS  Google Scholar 

  23. Smith MT, Perlis ML, Haythornwaite JA: Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity. Clin J Pain 2004, 20:111–118.

    Article  PubMed  Google Scholar 

  24. Fisher BJ, Haythornthwaite JA, Heinberg LJ, et al.: Suicidal intent in patients with chronic pain. Pain 2001, 89:199–206.

    Article  PubMed  CAS  Google Scholar 

  25. Smith MT, Edwards RR, Robinson RC, et al.: Suicidal ideation, plans and attempts in chronic pain patients: factors associated with increased risk. Pain 2004, 111:201–208.

    Article  PubMed  Google Scholar 

  26. Scholz J, Woolf CJ: Can we conquer pain? Nat Neurosi 2002, 5(Suppl):1062–1067. Two neural plasticity researchers present a richly illustrated and easy to understand primer on the cellular mechanisms of pain.

    Article  CAS  Google Scholar 

  27. Polantin PB, Dersh J: Psychotropic medication in chronic spinal disorders. Spine J 2004, 4:436–450.

    Article  Google Scholar 

  28. Gatchel RJ: Psychological disorders and chronic pain: cause and effect relationships. In Psychological Approaches to Pain Management: A Practitioner’s Handbook. Edited by Gatchel RJ, Turk DC. New York: Guilford Publications; 1996:33–52.

    Google Scholar 

  29. Max MB, Culnane M, Schafer SC, et al.: Amitryptiline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology 1987, 37:589–596.

    PubMed  CAS  Google Scholar 

  30. Feinmann C: Pain relief by antidepressants: possible modes of action. Pain 1985, 23:1–8.

    Article  PubMed  CAS  Google Scholar 

  31. Leo RJ, Barkin RL: Antidepressant use in chronic pain management: is there evidence of a role for duloxetine? Prim Care Companion. J Clin Psychiatry 2003, 5:118–123.

    Google Scholar 

  32. Maizels M, McCarberg B: Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician 2005, 71:483–490. The two authors present the most current overview of the data supporting the use of antidepressants and anticonvulsants in patients with chronic pain, including comprehensive tables that delineate useful individualized practice guidelines for various types of pain.

    PubMed  Google Scholar 

  33. Max MB, Lunch SA, Muir J, et al.: Effects of desipramine, amitryptiline and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992, 326:1250–1256.

    Article  PubMed  CAS  Google Scholar 

  34. Lynch ME: Antidepressants as analgesics: a review of randomized controlled studies. J Psychiatr Neurosci 2001, 26:30–36.

    CAS  Google Scholar 

  35. Sindrup SH, Bach FW, Madsen MD, et al.: Venlafaxine versus imipramine in painful polyneuropathy: a randomized controlled trial. Neurology 2003, 60:1284–1289.

    PubMed  CAS  Google Scholar 

  36. Arnold LM, Lu Y, Crofford LJ, et al.: A double-blind multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004, 50:2974–2984.

    Article  PubMed  CAS  Google Scholar 

  37. Patt RB, Proper G, Reddy S: The neuroleptics as adjuvant analgesics. J Pain Symptom Manag 1994, 9:446–453.

    Article  CAS  Google Scholar 

  38. Fishbain DA, Cutler RB, Lewis J, et al.: Do the second-generation "atypical neuroleptics" have analgesic properties? A structured evidence-based review. Pain Med 2004, 5:359–365.

    Article  PubMed  Google Scholar 

  39. Hagelberg N, Martikainen IK, Mansikka H, et al.: Dopamine D2 receptor binding in the human brain is associated with the response to painful stimulation and pain modulatory capacity. Pain 2002, 99:273–279.

    Article  PubMed  CAS  Google Scholar 

  40. Pridmore S, Oberoi G, Harris N: Psychiatry has much to offer for chronic pain. Aust N Z J Psychiatry 2001, 35:145–149. Pridmore et al. lay out an eloquent argument for the inclusion of psychiatrists in the multidisciplinary care of chronic pain patients. In support of their conclusion that psychiatry has much to offer chronic pain management, the authors provide a review of evidence supporting the emotional aspects of pain, co-occurring psychiatric disorders and the presence of "difficulty to treat" personality structures among patients with pain.

    Article  PubMed  CAS  Google Scholar 

  41. Olfson M: Depressed patients who do and do not receive psychiatric consultation in general hospitals. Gen Hosp Psychiatry 1991, 13:39–44.

    Article  PubMed  CAS  Google Scholar 

  42. Eisendrath SJ: Psychiatric aspects of chronic pain. Neurology 1995, 45(Suppl 9):S26–34.

    PubMed  CAS  Google Scholar 

  43. Fishbain D: Approaches to treatment decisions for psychiatric comorbidity in the management of the chronic pain patient. Med Clin North Am 1999, 83:737–759.

    Article  PubMed  CAS  Google Scholar 

  44. Weisberg JN: Personality and personality disorders in chronic pain. Cur Rev Pain 2000, 4:60–70.

    CAS  Google Scholar 

  45. Arnow BA: Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. J Clin Psychiatry 2004, 65(Suppl 12):10–15.

    PubMed  Google Scholar 

  46. Walling MK, O’Hara MW, Reiter RC, et al.: Abuse history and chronic pain in women: A multivariate analysis of abuse and psychological morbidity. Obstet Gynecol 1994, 84:200–206.

    PubMed  CAS  Google Scholar 

  47. Gruber AJ, Hudson JI, Pope HJ Jr: The management of treatment-resistant depression in disorders on the interface of psychiatry and medicine. Fibromyalgia, chronic fatigue syndrome, migraine, irritable bowel syndrome, atypical facial pain, and premenstrual dysphoric disorder. Psychiatr Clin North Am 1996, 19:351–369.

    Article  PubMed  CAS  Google Scholar 

  48. Leo RJ, Pristach CA, Streltzer J: Incorporating pain management training into the psychiatry residency curriculum. Acad Psychiatry 2003, 27:1–11.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Beth Israel Deaconess Medical Center, 1101 Beacon Street Brookline, 02446, MA, USA

    John Sharp MD, FAPA, FAPM

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  1. John Sharp MD, FAPA, FAPM
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  2. Brian Keefe MD
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Sharp, J., Keefe, B. Psychiatry in chronic pain: A review and update. Curr Psychiatry Rep 7, 213–219 (2005). https://doi.org/10.1007/s11920-005-0056-x

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  • DOI: https://doi.org/10.1007/s11920-005-0056-x

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