Psychiatric disorders and pain: The recurrence of a comorbidity

Abstract

Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.

Keywords: Pain; Sensory processing; Psychiatry; Nervous system; Sensitization

Core Tip: Chronic pain and psychiatric disorders concur often and the prevalence of this comorbidity outnumbers the odds of a mere coincidence. Identifying the first causative factor will be difficult, especially when the situation is complex and therapies have given poor results, if not failed completely. The debatable question of which comes first: The psychiatric disorder or the painful injury, nevertheless can be simplified within the model of a central sensitization, seemingly upheld from the model of PTSD and similar medical occurrences. Thus, an initial injury of psychological nature could lower pain perception threshold, and lead subsequently to chronic pain disorders.