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Pain behavior may influence pain perception, decision of whether to seek treatment, attitudes about and reactions to pain, relationship with health care provider and anger at health care system, functional ADL, and prognosis.

Pain is an extremely common complaint in patients with known emotional disorders and may be an associated symptom in virtually any psychiatric illness.

The AMA Guides note that with chronic pain there may not be impairment, but the patient may have variable amounts of disability and almost certainly a handicap.

Pain is a complex personal, subjective, unpleasant experience involving sensations and perceptions that may or may not relate to physical injury, tissue damage or nociception.

Pain may be influenced by psychosocial ethnic, genetic, religious, bichemical and other factors.

 Table 1.—Emotional Disorders Associated with Chronic Pain Syndromes

Somatoform Disorder

1. Somatization disorder

2. Conversion disorder

3. Somatoform pain disorder

4. Hypochondriasis

5. Atypical Somatoform

Affective disorders

Personality disorders

Psychological factors affecting physical conditions



Substance use disorders

*Adapted from Aronoff GM. Psychological Aspects of Nonmalignant Chronic

Pain: A New Nosology. In Aronoff GM. Evaluation and Treatment of Chronic

Pain. Baltimore, Md: Williams & Wilkins; 1992; 399-408.

Strange discusses the "chronic disability syndrome" in which individuals who are capable of working choose to remain disabled.

Disability is difficult to treat once it has continued for 6 months or longer. Thus, early recognition is important.

Often the patient's attitude and motivation, coupled with his or her support system, determines whether the pain becomes totally disabling.

Chronic pain research indicates that decreased function depends not only on pathophysiology but also on "illness behaviors" or "pain behaviors," eg, inactivity, drug misuse, learned helplessness. Patients with lengthy disabilities are special in several respects.

Snook found that patients receiving workers' compensation for back injuries were less likely to have objective findings or a definitive diagnosis than patients with back injuries who were not receiving compensation.

Many back-pain patients treated at pain programs have undergone multiple painrelated surgeries.


A disability evaluation must include a detailed medical, developmental, behavioral and psychosocial history to assess an individual's current and premorbid level of functioning.