The problem of psychiatric diagnosis for the pain patient in the general hospital

Because of the difficulty in applying psychiatric diagnostic nomenclature to the problem of pain in the medical setting, medical and surgical inpatients referred for a psychiatric consultation with pain as a presenting complaint (N = 167) are compared with 'nonpain' patients (N = 1,634). 'Pain' patients were more often male (p<0.05), had additional presenting problems of coping with their illness (p<0.0001), drug misuse and abuse (p<0.0001), and terminal illness (p<0.0001); evidenced less severity of psychiatric impairment (p<0.05); received different treatment recommendations; and were more likely to be assigned less frequently employed DSM-III psychiatric diagnoses than those most commonly found in consultation populations. However, these diagnoses were nonspecific for the problem of pain and provided minimal information about the nature of the pain. Enhancements of the diagnostic classification systems that would better address the nature of the psychiatric disorders associated with pain are presented.