Associated Features and Disorders
Associated descriptive features and mental disorders. Pain may severely disrupt various aspects of daily life. Unemployment, disability, and family problems are frequently encountered among individuals with chronic forms of Pain Disorder. Iatrogenic Opioid Dependence or Abuse and Benzodiazepine Dependence or Abuse may develop. A history of Substance Dependence or Abuse, whether with an illicit drug or a prescribed medication, increases the risk for the development of Dependence or Abuse on a controlled substance prescribed for pain management. However, even individuals without any history of Substance Dependence or Abuse are at some risk for developing these problems. As many as a quarter of individuals prescribed opioids for treatment of chronic pain may develop Abuse or Dependence. The risk of iatrogenic Substance Dependence can be minimized by ensuring that the individual with pain has had an appropriate evaluation to rule out the possibility of a treatable underlying etiology for the pain; that if other mental disorders are present, they are appropriately treated; and that medications are prescribed by a single physician rather than having the individual obtaining them from multiple sources. Substance Dependence or Abuse (mostly with alcohol) may complicate the lifetime illness course of Pain Disorder in up to a quarter of individuals with chronic pain.
Individuals whose pain is associated with severe depression and those whose pain is related to a terminal illness, most notably cancer, appear to be at increased risk for suicide. Individuals with recurrent acute or chronic pain are sometimes convinced that there is a health professional somewhere who has the “cure” for the pain. They may spend a considerable amount of time and money seeking an unattainable goal. Health care professionals may unwittingly play a role in fostering this behavior.
Pain may lead to inactivity and social isolation, which in turn can lead to additional psychological problems (e.g., depression) and a reduction in physical endurance that results in fatigue and additional pain. Pain Disorder appears to be associated with other mental disorders, especially Mood and Anxiety Disorders. Chronic pain appears to be most frequently associated with Depressive and Anxiety Disorders, whereas acute pain appears to be more commonly associated with Anxiety Disorders. The associated mental disorders may precede the Pain Disorder (and possibly predispose the individual to it), co-occur with it, or result from it. Both the acute and chronic forms of Pain Disorder are frequently associated with various sleep problems. Common sleep symptoms in individuals with chronic pain include delayed sleep onset, frequent awakenings, nonrestorative sleep, and decreased sleep time. Sleep Disorders such as obstructive sleep apnea and nocturnal myoclonus occur at higher rates among individuals with chronic pain than in the general population.
Associated laboratory findings. In Pain Disorder Associated With Both Psychological Factors and a General Medical Condition, appropriate laboratory testing may reveal pathology that is associated with the pain (e.g., finding of a herniated lumbar disc on a magnetic resonance imaging (MRI) scan in an individual with radicular low-back pain). However, general medical conditions may also be present in the absence of objective findings. Conversely, the presence of such findings may be coincidental to the pain.
Associated physical examination findings and general medical conditions. In Pain Disorder Associated With Both Psychological Factors and a General Medical Condition, the physical examination may reveal pathology that is associated with the pain. Pain Disorder can be associated with many general medical conditions. Among the most common general medical conditions associated with pain are various musculoskeletal conditions (e.g., disc herniation, osteoporosis, osteoarthritis or rheumatoid arthritis, myofascial syndromes), neuropathies (e.g., diabetic neuropathies, postherpetic neuralgia), and malignancies (e.g., metastatic lesions in bone, tumor infiltration of nerves). Attempts to treat the pain may lead to additional problems, some of which can cause more pain (e.g., use of nonsteroidal anti-inflammatory drugs resulting in gastrointestinal distress, overuse of acetaminophen resulting in hepatic disease, surgery resulting in adhesions).