Chronic pain, psychopathology, and DSM-5 Somatic Symptom Disorder
Open accessAbstract
Unlike acute pain that warns us of injury or disease, chronic or persistent pain serves no adaptive purpose. Though there is no agreed on definition of chronic pain, it is commonly referred to as pain that is without biological value, lasting longer than the typical healing time, not responsive to treatments based on specific remedies, and of a duration greater than 6 months. Chronic pain that is severe and intractable has detrimental consequences, including psychological distress, job loss, social isolation, and, not surprisingly, it is highly comorbid with depression and anxiety. Historically, pain without an apparent anatomical or neurophysiological origin was labelled as psychopathological. This approach is damaging to the patient and provider alike. It pollutes the therapeutic relationship by introducing an element of mutual distrust as well as implicit, if not explicit, blame. It is demoralizing to the patient who feels at fault, disbelieved, and alone. Moreover, many medically unexplained pains are now understood to involve an interplay between peripheral and central neurophysiological mechanisms that have gone awry. The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, somatic symptom disorder overpsychologizes people with chronic pain; it has low sensitivity and specificity, and it contributes to misdiagnosis, as well as unnecessary stigma. Adjustment disorder remains the most appropriate, accurate, and acceptable diagnosis for people who are overly concerned about their pain.
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Lower levels of anxiety and depression were found at pre-treatment compared to previous pain research, thereby impacting generalizability of findings to individuals experiencing more severe mood disruption.
“When compared to previous pain research (e.g., Katz et al., 2015), lower levels of anxiety and depression were found at pre-treatment thereby also impacting the generalizability of the findings to individuals experiencing more severe mood disruption.”
From Increasing access to pain management: Feasibility of a self-compassion psychoeducational website using a minimally monitored delivery model (2021) · cites this paper as Katz et al., 2015
All refinements of the chronic pain definition do not capture all varieties of chronic pain, and an acceptable definition is still lacking.
“However, all these refinements do not capture all the varieties of CP, and an acceptable definition is still lacking.6”
From <p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p> (2020) · cites this paper as [6]
Most of the emotional change seen in people with chronic pain is a consequence of physical disorder, and a common response to pain is some degree of depression, irritability, and anxiety.
“In 1989, Merskey14 identified that most of the emotional change seen in people with CP is a consequence of physical disorder and that a common response to pain will be some degree of depression, irritability, and anxiety, and the same conclusion has been drawn by Katz et al.6”
From <p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p> (2020) · cites this paper as [6]
Chronic pain is often defined by pain duration, yielding prevalence estimates ranging from 19% to 43%, or up to 116 million Americans.
“Chronic pain is often defined by pain duration,1,13,23,25,26 where pain persisting 3 to 6 months or more because onset can yield prevalence estimates for chronic pain ranging from 19 to 43%, or ≤ 116 million Americans.10,12,15,19,26”
From Prevalence and Profile of High-Impact Chronic Pain in the United States (2019) · cites this paper as [13]
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Long-Term Changes in Musculoskeletal Pain Sites in the General Population: The HUNT Study
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A Fatal Alliance between Microglia, Inflammasomes, and Central Pain
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Pain as a risk factor for suicidal ideation. A population-based longitudinal cohort study
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Neural changes after Emotional Freedom Techniques treatment for chronic pain sufferers
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Public stigma towards individuals with somatic symptom disorders - survey results from Germany
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Integrated cognitive behavioral therapy for chronic pain
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Pain modalities in the body and brain: Current knowledge and future perspectives
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Making Sense of “Somatization”: A Systematic Review of its Relationship to Pediatric Pain
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Chronic pain in the 11th revision of the International Classification of Diseases
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Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder
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The omnipresence of autonomic modulation in health and disease
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Pruriplastic Itch—A Novel Pathogenic Concept in Chronic Pruritus
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The thalamo-cortical complex network correlates of chronic pain
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Chronic Pain: Evolution of Clinical Definitions and Implications for Practice
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Pain and Perception: Exploring Psychedelics as Novel Therapeutic Agents in Chronic Pain Management
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Should I trust you? Investigating trustworthiness judgements of painful facial expressions
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Evolution of bodily distress disorders
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Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis?
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Chronic back pain and mental disorders
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Quality Pain Care for Older Adults in an Era of Suspicion and Scrutiny
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Understanding Nociplastic Pain: Building a Bridge between Clinical Psychology and Medicine
Galli, F. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13020310 · Cited by 10 · see citing works
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Therapeutic Implication of miRNAs as an Active Regulatory Player in the Management of Pain: A Review
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<p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p>
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An overview of ion channels therapeutics in the treatment of pain
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Intrathecal pain pumps in pain relief
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Etiology of testicular pain 2019: Classification into ten logical subgroups
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Musculoskeletal pain and working practices in the UK early childhood education workforce
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Somatic Symptom Disorder, Conversion Disorder, and Chronic Pain: Pediatric Clinician Perspectives
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Somatic Symptom and Related Disorders
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- Authors
- Katz, J., Rosenbloom, B. N., & Fashler, S.
- Affiliations
- York University (CA)
- Corresponding author
- Katz, Joel
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2015-04
- Volume
- 60
- Issue
- 4
- Pages
- 160-167
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC4459242
- OpenAlex
- W1878522659
- Cited by
- 195
- References
- 71
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 20 · 2023: 21 · 2022: 20 · 2021: 21 · 2020: 15 · 2019: 17 · 2018: 18 · 2017: 17 · 2016: 9 · 2015: 2 · 2013: 1
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- YorkSpace (York University) (submittedVersion)
- Canadian Psychiatric Association Journal
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- chronic pain, somatic symptom disorder, DSM-5, psychosomatic pain, medically unexplained pain, depression, anxiety, adjustment disorder, misdiagnosis, stigma, central sensitization, diagnostic validity, therapeutic relationship
- MeSH terms
- Humans, Somatoform Disorders, Diagnostic and Statistical Manual of Mental Disorders, Chronic Pain
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