Chronic pain ICD F454 persistent somatoform pain disorder

This syndrome involves persistent severe pain that cannot be explained by a physical disorder. An example would be a patient who has had an operation for back pain, but still has severe pain, or a patient who has been in a minor road traffic accident and sustained whiplash injuries, but is still complaining of incapacitating neck pain years later.

This can be a controversial category. In some cases, there are obvious psychological factors at play, but many of these patients vehemently deny any mental health aspect of their problems. Frequently, they are seen in pain clinics, often run by anaesthetists, where a variety of physical treatments (injections, TENS machines, medications, etc.) will be tried. A biopsychosocial model of pain is usually acknowledged, with a role for rehabilitation along cognitive-behavioural lines. Psychiatrists and psychologists sometimes have sessional commitments to such clinics. Dramatic improvements seem unusual in pain clinic patients.

It important to ensure that patients have appropriate antidepressant medication treatment as part of the management; tricyclics in proper doses have useful analgesic and anxiolytic properties, even if there is not a typical depressive syndrome present.

Particularly controversial aspects of chronic pain include the disputed syndrome of 'fibromyalgia', and individual cases where there are medico-legal or insurance claim dimensions.

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