Chronic Pain and Psychopathology: Research Findings and Theoretical Considerations

Abstract

Objective: Numerous studies have documented a strong association between chronic pain and psychopathology. Previous research has shown that chronic pain is most often associated with depressive disorders, anxiety disorders, somatoform disorders, substance use disorders, and personality disorders. The primary objective of this review article is to describe the nature of the relationship between chronic pain and each of these types of psychopathology. In addition, this article will explore how each of these disorders are expressed within the context of chronic pain, with a consideration of both diagnostic and treatment issues. Methods: Medline and PsychLit searches of the chronic pain/psychopathology literature from 1980 through 2000 were conducted using the keywords chronic pain, psychopathology, psychiatric disorders, and psychological disorders. Results: The relationship between chronic pain and psychopathology has generated substantial empirical and theoretical interest, with depressive disorders receiving much of the attention. Conclusions: Although no single theoretical model can fully explain the causal relationship between chronic pain and psychopathology, a diathesis-stress model is emerging as the dominant overarching theoretical perspective. In this model, diatheses are conceptualized as preexisting, semidormant characteristics of the individual before the onset of chronic pain that are then activated and exacerbated by the stress of this chronic condition, eventually resulting in diagnosable psychopathology.

Personality Traits and Subjective Health Complaints in Female TMD Patients and Healthy Controls

“…Moreover, affective and nociceptive pathways coincide anatomically, and the neurotransmittors serotonin and norepinephrine are involved in nociception as well as depression and anxiety [46]. It has been suggested that at least in some groups of chronic pain patients a trait of susceptibility to both pain and psychological symptoms may exist [47], perhaps due to an imbalance of the neurotransmitters involved in both conditions [46].…”

Mental Health and Physical Health (Including HIV/AIDS)

“…The various efforts to determine the causal direction between pain and depression may be organized in the following manner (Dersh et al, 2002):…”

“…For example, nociceptive (pain related) and affective pathways are thought to coincide anatomically; the neurotransmitters associated with mood disorders, namely norepinephrine and serotonin, have some involvement in the gate control mechanism described above; and antidepressant medication has been shown to relieve chronic pain (Dersh et al, 2002). It is apparent therefore that the relationship between chronic pain and depression is complex and dynamic, rather than linear and mechanistic.…”

Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders

“…Development of comorbid psychopathology also occurs at this Stage, including personality disorders, psychophysiological disorders, major depressive disorders, and substance abuse disorders (Dersh, Gatchel, Mayer, Polatin, & Temple, 2006;Dersh, Polatin, & Gatchel, 2002).…”