Specific Culture, Age, and Gender Features
There may be differences in how various ethnic and cultural groups respond to painful stimuli and how they express their reactions to pain. However, because there is so much individual variation, these factors are of limited usefulness in the evaluation and management of individuals with Pain Disorder.
Pain Disorder may occur at any age. Females appear to experience certain chronic pain conditions, most notably migraine and tension-type headaches and musculoskeletal pain, more often than do males.
Pain that causes significant distress or impairment in functioning is widespread. For example, it is estimated that, in any given year, 10%-15% of adults in the United States have some form of work disability due to back pain (only some of whom have Pain Disorder). However, the prevalence of Pain Disorder is unclear. Pain Disorder Associated With Both Psychological Factors and a General Medical Condition appears to be relatively common in certain clinical settings, particular those in which pain is a significant problem (e.g., pain clinics, psychiatric consultation services in a general medical hospital). Pain Disorder Associated With Psychological Factors appears to be much less common.
Most acute pain resolves in relatively short periods of time. There is a wide range of variability in the onset of chronic pain, although it appears that the longer acute pain is present, the more likely it is to become chronic and persistent. In most cases, the pain has persisted for many years by the time the individual comes to the attention of the mental health profession. Important factors that appear to influence recovery from Pain Disorder are the individual’s acknowledgment of pain; giving up unproductive efforts to control pain; participation in regularly scheduled activities (e.g., work) despite the pain; degree of pain reduction; recognition and treatment of comorbid mental disorders; psychological adaptation to chronic illness; and not allowing the pain to become the determining factor in his or her lifestyle. Individuals with greater numbers of painful body areas and higher numbers of general medical symptoms other than pain have a poorer prognosis.
Depressive Disorders, Alcohol Dependence, and chronic pain may be more common in the first-degree biological relatives of individuals with chronic Pain Disorder.