Pain Somatoform Disorder Workup

Updated: Oct 04, 2013
  • Author: Dolores Protagoras-Lianos, MD; Chief Editor: Caroly Pataki, MD  more...
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Workup

Laboratory Studies

The primary physician orders laboratory studies based on clinical suggestion of a specific medical condition.

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Imaging Studies

The primary physician orders imaging studies based on clinical suggestion of a specific medical condition.

Otti et al studied patients with somatoform pain disorder using resting functional MRI. Although the study demonstrated the resting functional network connectivity among pain-related interactions, it was unable to conclusively characterize the reasons for the pain [28]

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Other Tests

The diagnosis of pain disorder rests not only on the physician’s inability to fully explain the pain on an organic basis, but also on the presence of psychological factors. The following are prerequisite conditions for successful referral by a medical practitioner to a mental health professional:

  • Timely, thorough medical evaluation

  • Interview and observation of family for psychosocial problems

  • Early mention of possibility that symptoms are stress-related

  • Discussion of negative medical workup results

  • Rationale provided for mental health referral

  • Assurance of ongoing medical follow-up care and collaboration with mental health specialist

Mental health evaluation may involve the following:

  • Quantifying the pain: Faces Pain Scale–Revised (FPS-R) and Color Analog Scale (CAS) are self-report pain scales

  • Observation scales are used with preschool-aged children

  • Direct scaling techniques that ask that young children pick out from a graded series the drawings of faces that match the way they feel

  • Pain questionnaires for older children and adolescents

  • Screening instruments, such as the Child Behavior Checklist, to identify children with somatic symptoms and possible somatoform disorders

  • Trauma Symptom Checklist for Children

  • ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C)

  • Child Trauma Questionnaire-Short Form A self report questionnaire which may be used with adolescents [29]

  • Comprehensive structured interviews, such as the Diagnostic Interview for Children and Adolescents (DICA), that contain questions on somatization [29]

  • The Personality Inventory for Children (PIC), which has been used in the diagnosis of somatoform disorders in children

Projective tests that may help clarify underlying psychological issues and add to the evidence for a somatoform diagnosis include the Thematic Apperception test (TAT), the Children's Apperception Test (CAT), the Rorschach test, and sentence completion. Psychoeducational evaluation is recommended for patients with academic difficulties and prolonged school absence.

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