Opinion Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9550-9555
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9550
Psychiatric disorders and pain: The recurrence of a comorbidity
Gentian Vyshka
Gentian Vyshka, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Tirana 1005, Albania
Author contributions: Vyshka G has conceived and written the manuscript; revised it in the present version, and collected the references.
Conflict-of-interest statement: All authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gentian Vyshka, MD, Professor, Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Rr. Dibres 371, Tirana 1005, Albania. gvyshka@gmail.com
Received: May 8, 2022
Peer-review started: May 8, 2022
First decision: June 2, 2022
Revised: June 12, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: September 26, 2022

Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.

Keywords: Pain, Sensory processing, Psychiatry, Nervous system, Sensitization

Core Tip: Chronic pain and psychiatric disorders concur often and the prevalence of this comorbidity outnumbers the odds of a mere coincidence. Identifying the first causative factor will be difficult, especially when the situation is complex and therapies have given poor results, if not failed completely. The debatable question of which comes first: The psychiatric disorder or the painful injury, nevertheless can be simplified within the model of a central sensitization, seemingly upheld from the model of PTSD and similar medical occurrences. Thus, an initial injury of psychological nature could lower pain perception threshold, and lead subsequently to chronic pain disorders.