Comorbid Psychiatric Conditions

Chronic pain is not a unitary condition, rarely presenting alone. There is an extensive epi-demiological literature that supports the high prevalence of primary psychiatric disorders among persons with chronic pain. It is prudent, therefore, in the assessment of patients with chronic pain that one considers an extensive array of psychiatric comorbidities and that

Table 12.4 Multidimensional pain assessments.

Brief pain inventory

Originally developed in the assessment of pain severity and pain-related life interference among patients with cancer, this scale has increasingly been employed among patients with non-malignant pain. It is used to monitor response to treatment interventions (Cleeland and Ryan 1994). Coping strategies questionnaire

Assesses one's repertoire of coping strategies to deal with chronic pain; may predict the level of activity, physical impairment, and psychological functioning associated with pain (Rosenstiel and Keefe 1983). Fear-avoidance beliefs questionnaire

Assesses beliefs characterized by danger, threat, or harm associated with pain. The degree to which patients assign threat to activities may limit their participation in, and lead to avoidance of, activities related to work (Waddell et al. 1993). McGill pain questionnaire

Assesses the features of pain severity and intensity. Allows patients to qualify pain in emotional, cognitive, evaluative, and sensory terms (Melzack 1975).

Medical outcomes study short-form health survey - (SF-36)

Developed as a general measure of one's perceived health status, can be used to assess bodily pain; physical, emotional, and social functioning; and mental health (Ware and Sherbourne 1992). Minnesota multiphasic personality inventory-2

Comprises 567 true-false items that are used to derive scores on 10 clinical scales and 3 validity scales; employed to assess the psychological functioning of patients with pain (Hathaway et al. 1989). Multidimensional pain inventory

Assessment of one's appraisals of pain, its impact on functioning, and perceived responses of others in response to pain (Kerns et al. 1985).

Pain disability index

Comprises measures of disability, pain, and impact on activities of daily living; however, the instrument can be lengthy which may preclude using this instrument regularly in clinical practice (Tait et al. 1987). Survey of pain attitudes (SOPA)

Assesses the patient's beliefs and attitudes about pain, including perceived control over pain, perceived disability, need for avoidance of activity to prevent harm, and solicitousness (Jensen et al. 1987).

psychiatric treatment is secured whenever appropriate. The most commonly cited disorders are those which are outlined below; diagnosis of these conditions among persons with chronic pain requires the use of a clinical interview to assure that several specific criteria as established in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 2000) are met. Structured psychiatric interviews and diagnostic decision trees have been developed for facilitating reliable and valid diagnosis.

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