Psychiatry and Chronic Pain

Pain is currently the failure of analgesia. We have a comprehensive set of strategies, procedures, and drugs to manage pain and make it tolerable. However, some people suffer pain without relief, many of them with no known cause. There are numerous documents of the nineteenth and twentieth centuries that highlight the interest of psychiatry in chronic pain without injury. But nowadays the dedication of psychiatrists to this subject has been reduced: in a recent European population study on pain, psychiatrists are rarely cited as participating physicians in pain management. Why? Two reasons are identified. First, absence of an integrative nosography: the international classifications of mental disorders have not been able to frame the painful symptoms in a psychopathological context. Second, the peak of neurobiological interpretations that lead to a misunderstood dualism: when there is pain there must be a biological (mechanical) explanation, you just have to identify and treat it. Consequently, if psychiatrists wants to recover its role in the approach to pain, it must re-consider it as a phenomenon also mental. In addition, they need a psychopathological framework that overcomes the limitations of operational psychiatry of the international classifications of mental disorders. In this sense, phenomenological psychopathology, which  gatered the patient’s experiences lived in the first-person perspective, my be able to capture the subtle forms of experience and expression that constitute the “psychiatric object.”, essential for assessing the singularities of the pain experience in each patient.