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somatoform pain disorder (psychogenic pain, psychalgia)
Preoccupation with pain in the absence of adequate physical findings to account for the pain or its severity.
Clinical manifestations:
1) back pain*
2) headache*
3) atypical chest pain
4) functional abdominal pain
5) facial pain
6) musculoskeletal pain
* most common symptoms
Complications:
1) depression
2) suicide risk (hazzard ratio 3.0) [3]
Management:
1) non-narcotic analgesics
a) tylenol
b) non-steroidal anti-inflammatory drugs (NSAIDs)
c) similar efficacy
d) switching from one agent to another is often useful
2) antidepressants
a) useful in the absence of mood disorder
b) tricyclic antidepressants (TCA)
1] begin with lower doses than for depression
2] analgesia is dose-related
3] gradual increase of dose for non-responders
3) physical methods
a) spinal manipulation may be of benefit
b) transcutaneous electrical nerve stimulation (TENS) is NOT effective
4) chronic narcotics - referral to multidisciplinary pain clinic
Specific
fibromyalgia syndrome (fibromyositis, fibrositis)
General
somatoform (psychosomatic) disorder; somatic symptom & related disorders (SSRD)
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1105-1107
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Veterans Administration Memorandum Dec 24, 2009
Recent VHA Findings regarding chronic pain conditions and
suicide risk