Dolor perdurable I. Nosología y epidemiología / [Enduring pain I. Nosology and epidemiology].

ABSTRACT

Pain disorders are extraordinarily prevalent throughout clinical medicine, and are highly co-morbid with various psychiatric disorders, particularly those including depression or anxiety. Assessment of such patients tends to be based on diagnostic criteria that may not reflect the complexity of the clinical problem and can result in prioritizing somatic aspects of painful syndromes at the expense of psychiatric aspects or, conversely, over-emphasize psychiatric aspects. In the first part of this overview we consider current nosological perspectives and their potential clinical consequences, epidemiological data that underscore the association of comorbid painful and affective or anxious syndromes, and consider the importance of psychiatric assessment and treatment of such patients. The major overlap between pain disorders and psychiatric disorders, as well as the unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessing and clinically managing patients with chronic pain. Many programs for pain disorder patients offer narrowly specialized treatment options. To be preferred are multi-disciplinary teams with expertise in internal medicine, neurology, pain management, and rehabilitation, as well as psychology and psychiatry. In the second part of this overview, we propose that psychiatrists can serve a key role in leading comprehensive assessment and management of complex and challenging pain-psychiatric patients who are typically only partially responsive to available treatments.