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Chronic Pain and Psychopathology: Research Findings and Theoretical Considerations

From the PRIDE Research Foundation (J.D., P.B.P.), Dallas, Texas; and Departments of Psychiatry and Rehabilitation Sciences (R.J.G.), The University of Texas Southwestern Medical Center, Dallas, Texas.

Address reprint requests to: Robert J. Gatchel, PhD, Division of Psychology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-9044. Email: robert.gatchel{at}utsouthwestern.edu

ABSTRACT

OBJECTIVE: Numerous studies have documented a strong association between chronic pain and psychopathology. Previous research has shown that chronic pain is most often associated with depressive disorders, anxiety disorders, somatoform disorders, substance use disorders, and personality disorders. The primary objective of this review article is to describe the nature of the relationship between chronic pain and each of these types of psychopathology. In addition, this article will explore how each of these disorders are expressed within the context of chronic pain, with a consideration of both diagnostic and treatment issues.

METHODS: Medline and PsychLit searches of the chronic pain/psychopathology literature from 1980 through 2000 were conducted using the keywords chronic pain, psychopathology, psychiatric disorders, and psychological disorders.

RESULTS: The relationship between chronic pain and psychopathology has generated substantial empirical and theoretical interest, with depressive disorders receiving much of the attention.

CONCLUSIONS: Although no single theoretical model can fully explain the causal relationship between chronic pain and psychopathology, a diathesis-stress model is emerging as the dominant overarching theoretical perspective. In this model, diatheses are conceptualized as preexisting, semidormant characteristics of the individual before the onset of chronic pain that are then activated and exacerbated by the stress of this chronic condition, eventually resulting in diagnosable psychopathology.

Key Words: chronic pain, • psychopathology, • psychiatric disorders, • psychological disorders.

Abbreviations: CLBP = chronic low back pain;; DSM = Diagnostic and Statistical Manual of Mental Disorders;; MDD = major depressive disorder;; MMPI = Minnesota Multiphasic Personality Inventory;; PD = Personality Disorder;; SNAP = Schedule for Nonadaptive and Adaptive Personality;; SCID = Structured Clinical Interview for the DSM.

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