somatoform pain disorder (psychogenic pain, psychalgia)

Introduction

Preoccupation with pain in the absence of adequate physical findings to account for the pain or its severity.

Clinical manifestations

• back pain*
• headache*
• atypical chest pain
• functional abdominal pain
• facial pain
• musculoskeletal pain

* most common symptoms

Complications

• depression
• suicide risk (hazzard ratio 3.0)

Management

• non-narcotic analgesics
  • tylenol
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • similar efficacy
  • switching from one agent to another is often useful
• antidepressants
  • useful in the absence of mood disorder
  • tricyclic antidepressants (TCA)
    • begin with lower doses than for depression
    • analgesia is dose-related
    • gradual increase of dose for non-responders
• physical methods
  • spinal manipulation may be of benefit
  • transcutaneous electrical nerve stimulation (TENS) is NOT effective
• chronic narcotics - referral to multidisciplinary pain clinic

More general terms

• somatoform disorder

More specific terms

• fibromyalgia syndrome (fibromyositis, fibrositis)