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Pain disorder is when a patient experiences chronic pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may begin at any age, and occurs more frequently in girls than boys. This disorder often occurs after an accident or during an illness that has caused pain, which then takes on a 'life' of its own.

Diagnosis and Sub-diagnoses
The DSM-4 specifies two coded subdiagnoses: pain disorder associated with psychological factors and pain disorder associated with both physiological factors and general medical condition. Conditions such as dyspareunia, somatization disorder, conversion disorder, or mood disorders can eliminate pain disorder as a diagnosis. Diagnosis depends on an inability for physicians to explain the symptoms and on psychological influences.

Symptoms
Common symptoms of pain disorder are: negative or distorted cognition, such as feelings of despair or hopelessness; inactivity and passivity, in some cases disability; increased pain, sometimes requiring clinical treatment; sleep disturbance and fatigue; disruption of social relationships; depression and/or anxiety. Acute conditions last less then six months while chronic pain disorder lasts six or more months.

Epidemiology
At least once a week, 10-30% of those under 18 years of age suffer from unexplainable headaches and abdominal pains in the United States, and the number is rising. People from collectivistic countries such as Japan, China, and Mexico are more likely to suffer from pain disorder than individualistic countries such as the US and Sweden.

Demographics
Ethnicities show differences in how they express their discomfort and on how acceptable shows of pain and its tolerance are. Most obvious in adolescence, females suffer from this disorder more than males, and females reach out more. More unexplainable pains occur as people get older. Typically, younger children complain of only one symptom, commonly abdominal pains or headaches. The older they get, the more varied the pain location as well as more locations and increasing frequency.

Causes
The causes of pain disorder appear to be complex, including organic or medical etiologies such as injury, peptic ulcer and fibromyalgia; stress caused by continuing, severe or badly managed pain; impairment, loss and emotional distress, all of which may be caused by and in turn increase pain; and related depression and anxiety.

Theories
Psychodynamic theory: unconscious conflicts or desires are converted into somatic symptom to protect the conscious of the person from awareness of it Emotions and communication: children show distress in what may be the only way they can, physical symptoms, when they lack the ability to speak or express their thoughts in any way Social influences: where psychological disorders are frowned upon, whether in families or cultures, distress may be expressed in physical terms Learning theory: children learn to imitate a family member or pick up on possible gains of being "sick" Family systems theory: a child's role in a family may be the sick one as part of the family dynamics. Reasons why fall under four possibilities: enmeshment, overprotection, rigidity, lack of conflict resolution Trauma and abuse: this includes physical, psychological, or both combined with somatization. It is a common combination.

Treatment
Treatment may include psychotherapy (with cognitive-behavioral therapy or operant conditioning), medication (often with antidepressants but also with pain medications ), and sleep therapy. According to a study preformed at the University of Miami School of Medicine, antidepressants have an analgesic effect on patients suffering from pain disorder. In a randomized, placebo-controlled antidepressant treatment study, researchers found that "antidepressants decreased pain intensity in patients with psychogenic pain or somatoform pain disorder significantly more than placebo." Prescription and nonprescription pain medications do not help and can actually hurt if the patient suffers side effects or develops an addiction. Instead, antidpressants and talk therapy are recommended. CBT helps patients learn what worsens the pain, how to cope, and how to function in their life while handling the pain. Antidepressants work against the pain and worry. Unfortunately, many people do not believe the pain "is all in their head," so they refuse such treatments. Other techniques used in the management of chronic pain may also be of use; these include massage, transcutaneous electrical nerve stimulation, trigger point injections, surgical ablation, and non-interventional therapies such as meditation, yoga, and music and art therapy.

Beginning treatment
Before treating a patient, a psychologist must learn as many facts as possible about the patient and the situation. A history of physical symptoms and a psychosocial history help narrow down possible correlations and causes. Psychosocial history covers the family history of disorders and worries about illnesses, chronically ill parents, stress and negative life events, problems with family functioning, and school difficulties (academic and social). These indicators may reveal whether there is a connection between stress-inducing events and an onset or increase in pain, and the removal in one leading to the removal in the other. They also may show if the patient gains something from being ill and how their reported pain matches medical records. Physicians may refer a patient to a psychologist after conducting medical evaluations, learning about any psychosocial problems in the family, discussing possible connections of pain with stress, and assuring the patient that the treatment will be a combination between medical and psychological care. Psychologists must then do their best to find a way to measure the pain, perhaps by asking the patient to put it on a number scale. Pain questionnaires, screening instruments, interviews, and inventories may be conducted to discover the possibility of somatoform disorders. Projective tests may also be used.

Prevention
Early intervention when pain first occurs or begins to become chronic offers the best opportunity for prevention of pain disorder.