Psychiatric comorbidities are common in patients with chronic pain syndromes. Depression, anxiety, insomnia, somatic symptom disorder, substance use disorders, personality disorders, and problematic coping strategies present unique treatment challenges to pain medicine specialists. Patients with these comorbidities tend to have poorer response to treatment, higher rates of complications, and greater pain-related suffering. To reduce stigma, providers are encouraged to define pain as both a sensory and emotional experience. This intimate connection implies that optimal pain treatment requires concurrent attention to psychosocial well-being. Overlapping biological and psychologic mechanisms in the development of chronic pain and psychiatric disorders may contribute to the high rates of comorbidity. Methods for quickly identifying psychiatric disorders within busy clinic settings and brief interventions that pain specialists can deliver are described. Finally, indications for referral to specialty mental health and the benefits of multidisciplinary treatment, which can include psychiatric medications and evidence-based psychologic treatments, such as cognitive-behavioral therapy, are discussed.
Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood
