Psychiatrists are likely to see patients with pain in psychiatric, general hospital, and community settings. Pain is associated with a wide range of mental disorders and there are different ways in which this relationship may arise.
Pain may contribute to the cause of a mental disorder; for example, when a patient with cancer has pain, which is unrelieved by analgesics, and becomes depressed, this in turn may result in additional distress and disability as well as an exacerbation of pain. Treatment of depression may contribute to the relief from pain and improve the quality of life.
Psychiatrists working in a general hospital will see patients with acute pain, such as the patient with malignant disease referred to above, but more often will become involved in management at a later stage when pain has become chronic. Whatever the initial cause, the longer pain persists the more likely is it to result in the development of inappropriate patterns of illness behaviour and to have a profound effect on relationships with the family and other carers, resulting in more complex challenges for management and poorer prognosis.
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