Somatoform Pain Disorder 1
Reflection: Somatoform Pain Disorder
Shannon N. Phifer
Moraine Park Technical College
Somatoform pain disorder is classified as pain severe enough to disrupt someone’s daily living, but has no medical origin to support the pain an individual is experiencing. It is suggested that the pain is psychological in nature and may be a result of earlier trauma, either physical or emotional (A.D.A.M., 2012). It is important to note that not all individuals that are diagnosed with pain disorder have had a traumatic experience. Pain disorder is classified as a mental disorder because psychological factors are seen to contribute to the onset, severity, worsening and treatment of pain. However, the pain that the individual feels is real. Symptoms vary depending on the site of pain and are treated medically. However, there are common symptoms associated with pain disorder regardless of the site:
• Negative or distorted cognition, such as feeling helpless or hopeless with respect to pain and its management
• Inactivity, passivity, and/or disability
• Increased pain requiring clinical intervention
• Insomnia and fatigue
• Disrupted social relationships at home, work, or school
• Depression and/or anxiety
As researchers learn more about the connections between the brain and body, there is more evidence that emotional well-being affects the way in which pain is perceived (Disorders, 2013). There are multiple causes for pain disorder that may contribute to what the individual is experiencing, especially when the pain felt is chronic. According to the Encyclopedia of Mental Disorders, there are four domains of interest when evaluating pain disorder:
1. The underlying organic problem or medical condition, if there is one. For example, fibromyalgia (a pain syndrome involving fibromuscular tissue), skeletal damage, pathology of an internal organ, migraine headache, and peptic ulcer all have characteristic patterns of pain and a particular set of causes.
2. The experience of pain. The severity, duration, and pattern of pain are important determinants of distress. Uncontrolled or inadequately managed pain is a significant stressor.
3. Functional impairment and disability. Pain is exacerbated by loss of meaningful activities or social relationships. Disruption or loss may lead to isolation and resentment or anger, which further increases pain.
4. Emotional distress. Depression and anxiety are the most common correlates of pain, especially when the person suffering feels that the pain is unmanageable, or that the future only holds more severe pain and more losses.
Treatment of pain disorder can vary in medications and therapeutic approaches, but usually consists of a combination of both (Disorders, 2013). Because the physical affliction felt with pain disorder is real, it’s important to address both the physical pain and the psychological problems. First, a professional therapist should examine the psychological factors. Effective mental treatment includes cognitive-behavioral therapy, which allows the patient and the psychologist to understand where the pain is coming from and why it is affecting them. Through therapy, a patient is able to identify a cause and work towards an effective solution. Sometimes medications for other problems like anxiety or depression can be helpful; however, it’s important that the patient does not overuse pain medication, because it can cause other risk factors. Other forms of effective treatment include hypnotherapy, massage therapy, stress reducing exercises like yoga, and physical therapy (Staff, 2013).
Some of the common medications that are used to treat the psychological aspects of pain disorder are a category of medications known as Selective serotonin reuptake inhibitors (SSRIs) and include Prozac, Zoloft and Paxil. These medications can help with the pain and the worry that encompass the individual with pain disorder. Other medications used are Serotonin–norepinephrine reuptake inhibitors (SNRIs), and include Cymbalta, Effexor and Pristiq as well as Tricyclic antidepressants. Tricyclic antidepressants (TCAs) reduce pain, improve sleep, and strengthen the effects of opioids (such as codeine and oxycodone), as well as moderate depression. Relief of pain may occur in a few days while lessening of depression may take several weeks. Usually, TCAs for pain are prescribed at doses 33% to 50% lower than when prescribed for depression. TCAs are particularly effective for neuropathic pain, headache, facial pain, fibromyalgia, and arthritis. It is important though to note that these medications include side effects that can also have a negative effect on the individual. Some of the side effects include:
· Nausea· Insomnia
· Anxiety
· Restlessness
· Decreased sex drive
· Dizziness
· Weight gain / · Tremors
· Sweating
· Sleepiness or fatigue
· Dry mouth
· Diarrhea
· Constipation
· Headaches
It is important that individuals speak with their physician to discuss the possible side effects in order to minimize any surprise related to the side effects or further anxiety in regards to their pain disorder (Smith, Robinson, Segal, & Ramsey, 2013). Typically, pain medications are not used, and have been proven ineffective in treating pain disorder. They also carry a significant risk of addiction and/or abuse. Customary agents are acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs); if opioid analgesics are prescribed, they often are combined with NSAIDs so that the dosage of opioids may be reduced (Disorders, 2013). The goal of all the available treatments is to minimize the pain the individual is experiencing, while increasing their knowledge and coping skills related to the pain. The outcome for individuals diagnosed with pain disorder is promising, especially for individuals that have had only acute pain verses chronic pain. When individuals are able to begin activities that they use to enjoy before the pain, and enjoy them even through the pain, it is said that the outcome is even more promising (A.D.A.M., 2012).
When I first researched pain disorder, I admittedly had a hard time believing that this was a “real” disorder. My mother has chronic pain, yet test after test has not revealed any medical reason for her pain. Over the years, I became numb to her always blaming her actions (or lack of) on her pain, especially when all the doctors couldn’t define it’s’ cause. In turn, she has been on opiate pain medications and anti-depressants as long as I can remember to help control it. I always blamed the physicians for prescribing these medications because she has had significant side effects that have changed her mentally and physically. But, after doing further research on pain disorder, I have found myself more understanding of her chronic pain. I still disagree with the lack of interventions that her physicians have incorporated, and actually believe that she would benefit from CBT and other therapeutic techniques that do not include medications, especially pain medications. I am more comfortable speaking with her regarding her pain and can hopefully make some educated suggestions for pain management outside of medications. With continued research and understanding, I have hopes of becoming more supportive and empathic because I am finally realizing that this is not just an excuse for her, she is actually suffering from real pain.
References
A.D.A.M. (2012, September 12). PubMed Health: Somatoform Pain Disorder. Retrieved February 25, 2013, from U.S. National Library of Medicine: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001920/
Disorders, E. o. (2013). Pain Disorder. Retrieved February 26, 2013, from Mind Disorders: http://www.minddisorders.com/Ob-Ps/Pain-disorder.html
Smith, M. M., Robinson, L., Segal, J. P., & Ramsey, D. M. (2013, January). What You Need to Know About Medications for Depression. Retrieved Febraury 25, 2013, from HelpGuide.org: http://www.helpguide.org/mental/medications_depression.htm
Staff. (2013). Pain Disorder. Retrieved Febraury 27, 2013, from All About Counseling: http://www.allaboutcounseling.com/library/pain-disorder/