Last updated: Wed, Jul 31, 2024
This section discusses psychiatric conditions that are common among chronic pain patients. Most of the conditions discussed here correspond to diagnostic categories of the DSM manual, so they are conditions that are generally recognized in the current practice of psychiatry or clinical psychology.
When I came across the phrase, “sequelae and co-morbidities,” I chuckled grimly at how antiseptic the terms sound. “Sequelae,” as we should all know, means “things that follow.” “Co-morbidities” are illnesses that accompany some other illness. The idea is that chronic pain patients tend also to have a variety of other conditions that in the medical world are classified as psychological or psychiatric conditions. These include a high prevalence of depression, sleep problems and fatigue, anxiety, suicidality, and others. While about 8% of the U.S. population is depressed, 18 to 35% of those with chronic pain are reported to be depressed. About 6% of those with chronic pain have major depressive disorder (MDD). On the other hand, half to two-thirds of those with MDD also have painful physical symptoms.1 Those with more pain are more likely to be depressed. So there clearly is a link between pain and other problems.
What is the nature of that link? Does pain cause psychological problems, or do psychological problems cause pain? We have seen that it is often hard to distinguish correlation from causality. There is evidence about this, which will be presented in its place. The evidence fails to support some of the ideas about this that are most prejudicial toward pain sufferers. Some of these sequelae and co-morbidities are known to improve if the underlying pain can be treated.
In a practical sense, though, what is cause and what is effect may not matter much. In many cases there are treatments for these pain-related problems that are separate from pain treatment and that can be helpful even if the underlying pain problem can't be resolved. If you have any of the problems that are discussed in this section, you certainly should make your care providers aware of them and take advantage of any useful treatment that is available, despite any sense that there may be stigma attached. Please, for all of us.
Many different psychological/psychiatric/behavioral concepts and categories are applied to chronic pain patients. The list includes:
Some of these categories are clearly defined and clearly applicable, while others are neither but are still very much believed in. Most of them are causally connected with pain. Those of a certain turn of mind even wonder whether the psyche may not be responsible for some or even all of the pain. This section explores this area. Bear in mind that, for reasons that make sense in the medical world, these categories are seen as fairly distinct by those in the healing professions. They are, however, highly interrelated and often overlapping.