What is the risk of not including psychological treatment in pain management?
Pain patients have significant psychological comorbidity. Psychological syndromes found in the pain patient population include depression, anxiety, fear, sleep, appetite and sexual dysfunction, cognitive impairment, somatization, alexithymia, and negative emotions such as anger, hostility, and guilt. Occasionally, more severe psychological problems will develop, such as psychosis, dissociation, abuse of substances, addiction, eating disorders, or suicidal ideation. Psychological trauma is a frequent component of the chronic pain condition. People arrive at a pain state after a medical illness or a physical injury. These events are usually highly stressful, aversive, and can cause personality deterioration. Chronic illness can cause psychological trauma due to the burden of disruption of life goals and functioning. It is an established fact that a significant percentage of patients with pain disorders have had a history of psychological trauma. Often, one finds a significant history of childhood abuse (emotional, physical, and/or sexual), workplace harassment, domestic violence, and human rights abuses. Therefore, to omit a psychological perspective in evaluation and treatment of the person with pain is to neglect an essential etiological data point. If the psychological trauma is not treated, there is a risk the condition may worsen and the chronic nature may become intractable. This can lead to higher utilization costs and iatrogenic complications. It is important to understand there is a distinction between posttraumatic stress disorder and complex trauma. The former is usually a defined experience of a catastrophic event, while the latter indicates a more global deterioration in personality functioning. These can co-occur.