Chronic Pain

Although there are now proven behavioral and psychological methods of dealing with and alleviating chronic pain, methods that can supplement or replace drug treatments, these are not always applied in clinical practice. This volume in the series, Advances in Psychotherapy -- Evidence-Based Practice, provides psychological and medical therapists (and students) with practical and evidence-based guidance on diagnosis and treatment of chronic pain, and does so in a uniquely “reader-friendly” manner. The book is both a compact “how-to” reference, for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

Leseprobe:

1.6.2 Depression (p. 13)

Depression is common in patients with chronic pain, as it is in patients with other chronic medical disorders. Epidemiological studies have attempted to document the prevalence of depression in the chronic pain population, as well as to determine whether a causal relationship exists between pain and depression. Several factors make it difficult to obtain accurate estimates of the prevalence of depression in the chronic pain population. The first has to do with whether depression is defined as a mood state, a symptom, or a syndrome, and how it is measured. Prevalence estimates may vary depending on the definition of depression, and on whether mild depressive disorders such as dysthymia and adjustment disorder with depressed mood are included or excluded.

Assessment methods range from self-report questionnaires to structured interviews with strict diagnostic criteria. The stringency of the criteria with which depression is diagnosed also affects prevalence estimates.

The second difficulty is that there are overlapping symptoms between chronic pain and depression. The DSM-IV criteria for major depression include a number of somatic symptoms such as insomnia, fatigue or loss of energy, changes in appetite and/or weight, and diminished ability to think or concentrate, all of which may be partially or entirely attributable to the pain itself or the medications used to treat it. The problem of overlapping symptoms also exists in other medical conditions. Some authorities have recommended modified diagnostic criteria for major depression in the chronic pain population in which the symptoms attributed to pain would be omitted or substituted with alternative symptoms. However, most attempts at changing the diagnostic criteria for depression in the chronic pain population have not improved the accuracy of diagnosis and have yielded a high rate of false negatives. Thus, the DSM-IV criteria are still recommended.

In the DSM-IV-TR (American Psychiatric Association, 2000), symptoms of depression include: feelings of sadness, loss of interest in usual activities (anhedonia), diminished ability to think or concentrate, excessive or inappropriate feelings of guilt, fatigue or loss of energy, sleep, appetite, and weight disturbances, psychomotor agitation or retardation, and thoughts of death or suicide or a suicide attempt. The symptoms must cause significant distress or impairment and must not be attributable to effects of medication, substances, or a general medical condition. Although the prevalence of depression in the population of patients with chronic pain has been estimated to be as low as 10% to as high as 100% (using self-report measures), more stringent criteria have placed the estimate at 30–54% (Banks &, Kerns, 1996).

Kapitel:
0. Foreword and Table of Contents
1. 1. Description of the Disorder (22 Seiten)
2. 2. Theories and Models of the Disorder (6 Seiten)
3. 3. Diagnosis and Treatment Indications (17 Seiten)
4. 4. Treatment (41 Seiten)
5. 5. Case Vignette (4 Seiten)
6. 6. Further Reading (2 Seiten)
7. 7. References (5 Seiten)
8. 8. Appendix: Tools and Resources Initial Evaluation Questionnaire (13 Seiten)