Chronic Pain and Biopsychosocial Disorders
Accounting for over 35 million office visits a year, pain represents the most prevalent reason why an individual chooses to seek out medical treatment.1 So prevalent, in fact, research has shown that the cost associated with the treatment of pain exceeds the costs attributable to the treatment of other disorders, such as heart disease, respiratory disease, or cancer.2 Pain also represents a condition that has both medical and psychological components.
Chronic pain is widely regarded as a biopsychosocial disorder.3-8 Chronic pain and associated disability are often life-altering conditions, have a profound psychosocial impact, and psychiatric conditions are common in such patients. One study of an injured patient population found a 55% incidence of depression,9 where even minimal levels of depression were associated with increased rates of social morbidity and service utilization.10 Another study reported that of 1595 injured patients, 64% had one or more diagnosable psychiatric disorders, compared to a prevalence of 15% in the general population.11 In some cases, preexisting psychological conditions may predispose the patient to develop chronic pain. In other cases however, the psychological difficulties may be the consequence of the pain condition, itself.12 Thus, when pain appears in conjunction with stress, anxiety, depression or other psychiatric syndromes, the arrow of causality can sometimes point from pain to psychiatric condition, and in other cases from psychiatric condition to pain.
Overall, the research literature suggests that psychological difficulties are common among patients with pain. Left undetected and untreated, these difficulties may impede a patients progress in treatment and lead to long-lasting symptomatology. Among those who report pain and injury, psychosocial factors may play a major role in delayed recovery. One study of psychosocial factors demonstrated an ability to accurately predict delayed recovery for patients suffering acute pain 91% of the time without using medical information.13 Another study found that psychosocial factors play a dominant role in surgical outcome.14 Lastly, in a World Health Organization study of 25,916 medical patients from around world, psychological factors were found to be a stronger contributor to disability than was disease severity.15
While chronic pain is generally recognized as being a biopsychosocial phenomenon, what is often overlooked is that illness, injury, psychological and social factors interact over the course of time to produce distinctly different types of biopsychosocial disorders. Effective treatment requires that the clinician not only identify the biological, psychological and social aspects of a condition, but also understand how each component interacts.
Please refer to the Nov/Dec 2005 issue for the complete text. In the event you need to order a back issue, please click here.