Identifying and Assessing Overlapping Chronic Pain and Mental Illness

Psychiatric comorbidity profoundly affects outcomes in chronic pain. Chronic pain alters the clinical appearance of psychiatric conditions. Problems of poor coping, limited life skills, poor social and behavioral modeling, limited resources, and poor self-efficacy all can complicate and exacerbate chronic pain disorders. Operant and classical mechanisms with inadvertent rewards for illness-related behaviors condition the behaviors associated with chronic pain. Iatrogenic addiction can also make it difficult for patients to engage in functional rehabilitation. Features of temperament, including extraversion and instability, lead to maladaptive responses to managing pain and difficulty engaging with physicians and health care professionals. Lastly, diseases of mood decrease the normal capacity to experience rewards associated with healthy behavior and divert patients toward avoidance coping, nihilistic views of recovery, and disengagement from support systems and medical care. A coherent and comprehensive diagnostic formulation including these elements leads to effective interdisciplinary rehabilitative pain treatment.