Comorbidity

Pain disorder is commonly associated with anxiety and depression, and an additional diagnosis of anxiety disorder or mood disorder can be made if the criteria for both diagnoses are satisfied. This dual diagnosis can be useful if, for example, a depressive disorder develops in the presence of a long-standing pain disorder. Any temporal relationship can occur, however, with pain onset preceding, developing simultaneously, or following the onset of a mood disorder.

Other common comorbid diagnoses include substance abuse and dependence, sometimes of iatrogenic origin, and in some centres, particularly in the United States, the management of narcotic dependence has been an important component of pain-treatment programmes. Finally, personality disorders are an additional category of comorbidity. No single disorder predominates but histrionic, narcissistic, anxious (avoidant), and dependent features are all common in clinical practice, and anankastic traits may feed the inflexible focus on physical illness.

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