Last updated: Mon, Jul 3, 2017
The criteria for psychogenic pain disorder in DSM-III were judged unsatisfactory, and when the revision of DSM-III was released in 1987, the disorder had been renamed somatoform pain disorder. The psychological criteria were entirely removed from the definition. This left a simpler definition: 1) The patient must have been preoccupied with pain
for at least six months, and either of two other criteria; either 2) medical evaluation found no organic or physiologic mechanism, or 3) the pain or impairment was grossly in excess of what would be expected.
(This definition would, of course, have fit most sufferers from fibromyalgia at that time.) It defined as somatoform pain disorder, in fact, any painful pathology that is not clinically provable. It alternatively relied on the judgment of the psychiatric practitioner as to what is grossly in excess
of expected.
A later group working on the definition for the DSM-IV-TR revision found serious problems with this formulation. One study anesthetized patients who had no objective findings intrathecally, that is, inside the membrane that surrounds the spinal cord. In this study, 91% of these patients responded to the spinal anethesia just as patients who have physical findings do. This of course cast significant doubt on the idea that the symptoms were of psychic origin (although, they tell us, the subconscious is very crafty). A 1998 review found that antidepressant treatment of patients diagnosed with somatoform or psychogenic pain was effective in relieving the pain of these patients. This casts doubt on whether these disorders should in fact be conceived of as distinct from depressive disorders.1 2