Chronic Pain and Psychiatric Symptoms

Michael R. Clark, MD, MPH, MBA, Joyce King, MD, and Glenn J. Treisman, MD, PhD

Michael R. Clark, MD, MPH, MBA
Associate Professor & Director, Chronic Pain Treatment Program
Department of Psychiatry & Behavioral Sciences
The Johns Hopkins Hospital
Baltimore, MD

Joyce King, MD
Chair, Patient Care Advisory Committee
Director, Inpatient Training for Family Practice Residents
Franklin Square Hospital
Baltimore, MD

Glenn J. Treisman, MD, PhD
Professor of Psychiatry and Behavioral Sciences and of Medicine
Director, AIDS Psychiatry Service
The Johns Hopkins University School of Medicine
Baltimore, MD

Chronic pain is often comorbid with affective symptomatology. In fact, mood disorders are predictive of the onset of new chronic pain syndromes more than a decade into the future. Clinicians must therefore be prepared to discriminate among relevant variables to determine the most important factors contributing to pain and psychiatric symptoms. Each patient presenting with persistent pain should undergo a complete evaluation to inform an individualized multimodal treatment plan. Functional goals are critical, providing important markers for a comprehensive approach to treatment and encouraging patients to take positive steps in their own care. Incorporating a psychological approach with medical techniques to treat chronic pain helps identify the patient as an individual who is afflicted with a painful condition, struggling with daily events, and motivated to achieve functional goals. Here, Drs Treisman, King, and Clark discuss the challenges of assessing and comanaging pain and psychiatric symptoms, and methods to educate patients on the need for psychosocial therapies.

References

1.    Jordan KD, Okifuji A. Anxiety disorders: differential diagnosis and their relationship to chronic pain. J Pain Palliat Care Pharmachother. 2011;25:231-245.
2.    Clark MR. Psychiatric Issues in Chronic Pain. Curr Psychiatry Rep. 2009;11:243-250.
3.    Demyttenaere K, Bruffaerts R, Lee S, et al. Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys. Pain. 2007;129:332-342.
4.    Larson, SL, Clark MR, Eaton WW. Depressive disorder as a long-term antecedent risk factor for incident back pain: a 13-year follow-up study from the Baltimore Epidemiological Catchment Area sample. Psychol Med. 2004;34:211-219.

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