Avramenko O. Clinical polymorphism of chronic pain in patients with non-psychotic mental disorders (diagnostics, principles of therapy)

Was examined 135 patients with chronic pain: combined with depressive disorders - 32 people; combined with anxiety disorders - 34 people; coupled with anxiety-depressive disorders - 33 people; without mental disorders - 36 people. Was evaluated the mental state of patients, quality of life and multifactorial assessment of chronic pain characteristics. Was described structure and clinical psychopathology of mental disorders. Noted the prevalence of depressive-hypochondriac syndrome in patients with depressive disorders, nearly uniform distribution on anxiety-hypochondriac, anxiety-depressive and anxiety-phobic syndromes in patients with anxiety disorders, the dominance of anxiety-depressive syndrome and the presence of hypochondriacal component in patients with anxiety and depressive disorders . In clinical structure of non-psychotic mental disorders it was noted the presence of clinically significant depression and anxiety with some predominance of the latter; decline in the quality of life of patients was primarily due to physical and emotional role functioning and pain intensity. Was determined that the presence of mental disorders hampered awareness of pain behavior and gave an additional impulse to its formation. Multifactor assessment of chronic pain characteristics showed a link between high levels of disasterization pain, its intensity and emotional distress. Was proven that the presence of depression combined with anxiety creates some barriers to treating patients with chronic pain and partially defines the passive role of the patient in the treatment process. Was determined that patients with chronic pain and non-psychotic mental disorders are not suitable for continuous opioid analgesia and are prone to the formation of pain behavior, especially in combination of anxiety and depression. Complex diagnostic algorithm for patients with non-psychotic mental disorders and chronic pain has been developed, it included the identification of mental disorders, multifactorial assessment of chronic pain, pain behavior detection with appropriate social and behavioral traits. Were created the basic principles of supervision and quality indicators of the treatment process.