Pain Physician, Volume 5, Number 1, pp 57-82 2002, American Society of Interventional Pain Physicians ® ISSN 1533-3159 Review Article 57 Understanding Psychological Aspects of Chronic Pain in Interventional Pain Management Laxmaiah Manchikanti, MD*, Bert Fellows, MA # , and Vijay Singh, MD** From Pain Management Center of Paducah, Paducah, Kentucky and Pain Diagnostic Associates, Niagara, Wis- consin. *Medical director and # psychologist at Pain Man- agement Center of Paducah. **Medical director of Pain Diagnostic Associates. Address Correspondence: Laxmaiah Manchkianti, MD, 2831 Lone Oak Road, Paducah, KY 42003. E-mail: drm@asipp.org There is no doubt that chronic pain is recognized as a biopsychosocial phenomenon in which biological, psycho- logical, and social factors dynamically interact with each other. Thus, the role of psychological factors and under- standing chronic, persistent disabling pain has been well recognized, but poorly understood. Approximately1/2 to 2/3 of all patients diagnosed with chronic pain manifest to various levels of psychological distress. Chronic pain and psychological disorders are the two most common elements in the United States. Statistics show that, approximately 22% of Americans suffer from a diagnos- able mental disorder in a given year. In addition, 28% of the American population suffers with chronic pain. De- pression in chronic pain is the most common condition, fol- lowed by generalized anxiety disorder, somatization disor- der, and drug dependence. However, psychogenic pain ap- pears to be the least prevalent of all psychopathological is- sues. Chronic pain disability is a complex psychosocial economic phenomenon. There is no data in the literature with regards to treatment of personality disorders, anxiety disorders, and somatization disorders in managing chronic pain. In con- trast, treatment of depression and the influence of treatment on outcomes have been studied to some extent. In conclusion, patients with chronic pain frequently have psychopathology – most often common depressive disor- ders, anxiety disorders, somatization disorders, drug depen- dence and occasionally personality disorders. This review discusses various issues involved with psychopathology in chronic pain including epidemiology; relationship of psy- chopathology to pain; influence of depression, generalized anxiety disorder, somatization, and personality disorders on chronic pain, along with diagnosis and management in interventional pain management. Keywords: Chronic pain, Psychophysiology, psychopa- thology, biopsychosocial approach, depression, generalized anxiety disorder, somatization disorder Chronic pain is recognized as a multidimensional prob- lem with both sensory and affective components, and is viewed as a biopsychosocial phenomenon in which bio- logical, psychological and social factors dynamically in- teract with each other (1-3). Thus, the role of psychologi- cal factors in understanding chronic, persistent disabling pain has been well recognized. The fact that chronic pain patients present with a wide range of associated emotions is not only well known, but overemphasized (3-14). Ap- proximately one half to two thirds of all patients diagnosed with chronic pain manifest various levels of psychosocial distress. A significant proportion of patients with chronic pain are diagnosed with reactive disorders, including de- pression, anxiety, somatization, personality disorders and various nonspecific issues, such as emotion, anger, and loss of self-esteem (3-14). However, the high rates of reac- tive disorders in patients with chronic pain, even though well recognized, are very poorly understood. Any discus- sion of psychiatric disorders in patients with chronic pain is haunted by the concept of psychogenic pain (2). Con- tinued exploration of the psychological factors in chronic pain, with an inordinate interest in this subject, have re- sulted in an explosion of literature. Psychological abnor- malities, their diagnosis and management is an integral part of interventional pain management. Thus, psychological issues are not only challenging for an interventional pain practitioner, but also mandate that pro- vider develop insight into these issues. Psychological issues may influence significantly the diagnosis, progno- sis and outcomes.