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Tthere are two psychologically based pain disorders. "Pain Disorder Associated With Psychological Factors" is diagnosed when psychological factors play a major role and medical condition plays minimal or no role.

"Pain Disorder Associated With BOTH Psychological Factors and a General Medical Condition" is quite often diagnosed in work-related injuries in which psychological factors impact the onset, severity, exacerbation or maintenance of pain.

It is a quite common disorder with 10-15% of American's claiming disability each year due to back pain alone.

Tags: atlanta, dr. david b. adams, psychologist, somatoform disorder

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Pain

A patient complains of a range of physical complaints that do not logically follow from her injury. She injured her knee and hip, but she has chest, abdominal, arm, neck, head and urinary complaints. Every few weeks more complaints emerge. She may not be malingering.

There are a range of somatoform disorders in which the expression of fears and needs are expressed through bodily complaints. Soma means body. Thus, somatoform, in essence, means "taking the form of bodily complaints." What is missing is having access to that which is truly bothering her. Is she frightened of the original complaint and its consequences. Is she fearful of recovery and its responsibilities or does she need her complaints in order to cling to one or more relationships that would otherwise fail? These are the things for which she would need to be examined.

Tags: atlanta, dr. david b. adams, psychologist, workers' compensation

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Symptoms

It is often uncertain as to how many back injured patients understand or are capable of understanding their complaints. They actually seem offended by their diagnostic information and distrustful that it is even accurate."

Dr. Adams: At the request of an orthopedic surgeon, I recently saw a patient who had two prior, unsuccessful back surgeries. His third surgeon told him that he had significant scar tissue and that further surgery would be counterproductive.

The surgeon recommended that the patient consider conservative care and also at the possibility that he would have to learn to cope with the pain; that the pain may be chronic.

The patient became angered, told me that the surgeon was "not being positive enough". This meant, in actuality, that the patient was frightened by the information and was blaming the messenger (surgeon) for the message.

We talk about psychological diagnosis, but I should note ...

Tags: atlanta, dr. david b. adams, psychologist, workers' compensation

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Pain

Many of my patients are divorced and many have, or have had, sexual problems or conflicts. In 1997, there were 2.3 million marriages. Sixty percent of Americans were married at that time, 23% had never married, 9% were divorced, and 7% were widowed. Fifteen percent of Americans are single parents, 45% rely upon dual income and only 20% maintain the traditional breadwinner/homemaker roles. Fifty-three percent of couples have no children. The average is 1.84 children per family. Sixty-eight percent live with mom and dad; twenty-four percent live with their mother; 4% live with their father. Six percent of families have incomes above $100k and sixteen percent have incomes below $10k. Eleven percent of males had been sterilized as compared to 28% of females. Seven percent of women are homosexual, and thirteen percent of males. Of the 1.3 million prostitutes in the U.S., 500 thousand were under the age of 18, and 100 thousand of all prostitutes had been arrested. Thirty-eight percent of girls ...

Tags: atlanta, dr david b. adams, psychologist, workers' compensation

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The Sociology of Injury

It is extremely important to determine to what degree a patient is self-medicating and complicating his/her own recovery process

In the acute (short term) treatment of pain, aggressive pain management can prevent the patient from developing fear and hopelessness regarding the future. However, many patients will attempt to adjust their own dosage levels, borrow medication from friends/relatives and mix the medication with alcohol and other agents (eg. marijuana, cocaine, etc).

Patients believe that the goal for chronic pain is to eliminate all experiences of discomfort rather than beginning the difficult process of adjusting to residual pain and building a life that does not have its basis in a pain-free existence.

I believe our greatest error is not discussing with a patient the concept of residual pain, means of coping with that pain, and adjustments to life style that may be required. We often leave patients with the belief that there will ...

Tags: atlanta, dr. david b. adams, medication, workers' compensation

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Obstacles