Igor Elman, M.D.
Associate Professor of Psychiatry
Emotional disturbances may arise in psychiatrically healthy people exposed to chronic pain. This is very common in patients with comorbid neuropsychopathology affecting the same brain circuits involved in the processing of emotions. The list of psychiatric ailments associated with heightened pain prevalence in at least one extant epidemiological survey would encompass all DSM-IV-TR diagnostic categories.
This presentation addresses three common syndromes representing the entire spectrum of aberrant pain possessing from the relative pain insensitivity in schizophrenia to the amplified perception of pain in post-traumatic stress disorder and in major depression. It summarizes the mechanisms involved in the mediation of pain and analgesia, as they relate to the normal processing of emotions, reward and motivation as well as the altered mechanisms encountered in those afflicted with these syndromes. Dr. Elman discusses the psychosocial-biological therapeutic continuum available for the treatment of pain in psychiatric patients. The dialectical perspective on pain alleviation while preventing, diagnosing, and treating potential addiction to prescription opioid pain killers will be specifically addressed.
Dr. Elman advocates for a wide-ranging involvement of psychiatrists in the management of pain in order to invigorate essential elements of evaluation and treatment that may be underutilized by some clinicians.