ABSTRACT
This chapter is primarily concerned with psychiatric issues in chronic pain. Most patients with a psychiatric disorder seen in a pain clinic will have had a preexisting psychiatric illness or will have developed mental illness because of their chronic painful illness. Depressive illness is the most common associated psychiatric disorder that is found in patients with chronic pain. The three most typical symptoms of a depressive illness are: depressed mood; loss of interest and pleasure; and loss of energy and increased fatigue. Anxiety disorders have been found to be correlated more closely than depression with chronic painful conditions in a large US sample of chronic pain patients. Panic disorder comprises severe unpredictable anxiety episodes that can occur “out of the blue,” although they are usually more common in one situation than another. The difficulty for the nonpsychiatric physician in examining a patient with long-standing pain is in differentiating distress from illness.
