Pain Disorder: This is when a person experiences pain in specific areas. It can cause a disability in the daily tasks people can complete. Classified a mental disorder because psychological factors play a role.

Normally pain is good, it tells you when something is going wrong in your body. But when pain turns into chronic where it never turns off thats when it turns into a disorder.

Biological Influences:
-Activity in spinal cords large and small fibers
-genetic differences in endorphin production
-the brains interpretation of CNS activity

Psychological Influences:
-attention to pain
-learning based on experiences

Social-Cultural Influences:
-presence of others
-empathy for others pain
cultural expectations


  • The underlying organic problem or medical condition, if there is one. For example, fibromyalgia (a pain syndrome involving fibromuscular tissue), skeletal damage, pathology of an internal organ, migraine headache, and peptic ulcer all have characteristic patterns of pain and a particular set of causes.
  • The experience of pain. The severity, duration, and pattern of pain are important determinants of distress. Uncontrolled or inadequately managed pain is a significant stressor.
  • Functional impairment and disability. Pain is exacerbated by loss of meaningful activities or social relationships. Disruption or loss may lead to isolation and resentment or anger, which further increases pain.
  • Emotional distress. Depression and anxiety are the most common correlates of pain, especially when the person suffering feels that the pain is unmanageable, or that the future only holds more severe pain and more losses.


  • negative or distorted cognition, such as feeling helpless or hopeless with respect to pain and its management
  • inactivity, passivity, and/or disability
  • increased pain requiring clinical intervention
  • insomnia andfatigue
  • disrupted social relationships at home, work, or school
  • depression and/or anxiety

Diagnostic criteria for Pain Disorder (cautionary statement)

A. Pain in one or more anatomical sites is the predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention.
B. The pain causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. Psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain.
D. The symptom or deficit is not intentionally produced or feigned (as in Factitious Disorder or Malingering).
E. The pain is not better accounted for by a Mood, Anxiety, or Psychotic Disorder and does not meet criteria for Dyspareunia.

307.80 Pain Disorder Associated With Psychological Factors: psychological factors are judged to have the major role in the onset, severity, exacerbation, or maintenance of the pain. (If a general medical condition is present, it does not have a major role in the onset, severity, exacerbation, or maintenance of the pain.) This type of Pain Disorder is not diagnosed if criteria are also met for Somatization Disorder.
Specify if:
  • Acute: duration of less than 6 months
  • Chronic: duration of 6 months or longer

307.89 Pain Disorder Associated With Both Psychological Factors and a General Medical Condition: both psychological factors and a general medical condition are judged to have important roles in the onset, severity, exacerbation, or maintenance of the pain. The associated general medical condition or anatomical site of the pain (see below) is coded on Axis III.
Specify if:
  • Acute: duration of less than 6 months
  • Chronic: duration of 6 months or longer
  • Note: The following is not considered to be a mental disorder and is included here to facilitate differential diagnosis.

Pain Disorder Associated With a General Medical Condition: a general medical condition has a major role in the onset, severity, exacerbation, or maintenance of the pain. (If psychological factors are present, they are not judged to have a major role in the onset, severity, exacerbation, or maintenance of the pain.) The diagnostic code for the pain is selected based on the associated general medical condition if one has been established or on the anatomical location of the pain if the underlying general medical condition is not yet clearly established--for example, low back (724.2), sciatic (724.3), pelvic (625.9), headache (784.0), facial (784.0), chest (786.50), joint (719.4), bone (733.90), abdominal (789.0), breast (611.71), renal (788.0), ear (388.70), eye (379.91), throat (784.1), tooth (525.9), and urinary (788.0).

Treatment of pain disorder
The treatment of pain associated with a psychiatric disorder is the treatment of the primary condition. Skill is required to maintain a working relationship with patients unwilling to accept a psychological basis for their pain. Any associated physical disorder should be treated and adequate analgesics provided.
The management of chronic pain should be individually planned, comprehensive, and involve the patient's family. Any physical cause must be treated. Psychological care is directed to two issues:
  • whether there is an associated mental disorder. This assessment should be made on positive findings and not solely because no specific organic cause has been identified. If depressive illness is present it should be treated vigorously. Antidepressant medication may also be effective in patients with chronic pain in the absence of evidence of a depressive disorder (O'Malley et at 1999).
  • whether the pain or any associated behaviors can be modified by using psychological techniques.
Behavioral treatments are useful. However, many patients with chronic pain lack the motivation needed to make full use of these methods. In some cases such treatment aims to reduce social reinforcement of maladaptive behavior, and to encourage the patient to seek ways to overcome disability. See Morley et at. (1999) for a review.
Pharmacological and behavioral therapies may be combined for some patients. Multidisciplinary pain clinics provide expertise in and resources for arrange of treatments. Although many patients are unwilling to accept such treatment and others are considered unsuitable, the evidence is that they are cost-effective for participants.

Pain disorder may be prevented by early intervention. i.e., at the onset of pain or in the early stages of recurring pain. When pain becomes chronic, it is especially important to find help or learn about and implement strategies to manage the distress before inactivity and hopelessness develop. Most patients in pain first contact their primary care physician who may make a referral to a mental health professional or pain clinic. Many physicians will reassure the patient that a referral for psychological help is not stigmatizing, does not in any way minimize the experience of pain or the medical condition, and does not imply that the physician believes the pain is imaginary. On the contrary, the accepted IASP definition of pain fully recognizes that all pain is, in part, an emotional response to actual damage or to the threat of damage.