Presented is a case report of a 55-year-old man with a suspected diagnosis of pancreatic malignancy who was referred for pain management to the pain and palliative care clinic. A diagnosis of pain originating from a malignancy was later ruled out. The patient was referred for psychiatric evaluation, where his pain symptoms were confirmed to be somatoform in origin. This case highlights the importance of ruling out somatization as the cause of symptoms in difficult pain patients.
National Institute of Public HealthD. SUSY: Sundhedsogsygelighedsundersøgelsen 2000. Available at: www.sifolkesundhed.dk/ussy/sammenfatning.htm. Accessed 2003.
2.
Kroenke K. , Mangelsdorff ADCommon symptoms in ambulatory care: incidence, evaluation, therapy and outcome . Am J Med.1989;86: 262-266 .
3.
Fink P. , Sorensen L. , Engberg M. , Holm M. , Munk-Jorgensen P.Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition . Psychosomatics. 1999;40: 330-338 .
4.
Toft T.Managing Patients with Functional Somatic Symptoms in General Practice. PhD thesis, Faculty of Health Sciences , University of Aarhus , Denmark, 2004.
5.
Goldberg D. , Bridges K.Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire . J R Coll Gen Pract. 1987;37: 15-18 .
6.
Fink P.The use of hospitalizations by persistent somatizing patients . Psychol Med.1992;22: 173-180 .
7.
Fink P.Surgery and medical treatment in persistent somatizing patients . J Psychosom Res.1992;36: 439-447 .
8.
McDaniel SH , Campbell T. , Seaburn D.Somatic fixation in patients and physicians: a biopsychosocial approach . Fam Syst Med.1988;7: 5-16 .
9.
Salmon P. , Peters S. , Stanley I.Patients' perceptions of medical explanations for somatization disorders: qualitative analysis . BMJ.1999;318: 372-376 .
10.
Dowrick CF , Ring A. , Humphris GM , Salmon P.Normalisation of unexplained symptoms by general practitioners: a functional typology . Br J Gen Pract.2004; 54: 165-170 .
11.
Butler CC , Evans M.The ``heartsink'' patient revisited. The Welsh Philosophy and General Practice Discussion Group . Br J Gen Pract.1999;49: 230-233 .
12.
Smith GR, Jr , Monson RA , Ray DCPatients with multiple unexplained symptoms: Their characteristics, functional health, and health care utilization . Arch Intern Med.1986;146: 69-72 .
13.
Barsky AJ , Ettner SL , Horsky J. , Bates DWResource utilization of patients with hypochondriacal health anxiety and somatization . Med Care.2001;39: 705-715 .
14.
Hansen MS , Fink P. , Frydenberg M. , Oxhoj MLUse of health services, mental illness, and self-rated disability and health in medical inpatients . Psychosom Med.2002 ; 64: 668-675 .
15.
Speckens AE , van Hemert AM , Spinhoven P. , Hawton KE , Bolk JH , Rooijmans HGCognitive behavioural therapy for medically unexplained physical symptoms: A randomized controlled trial . BMJ. 1995;311: 1328-1332 .
16.
Lidbeck J.Group therapy for somatization disorders in general practice: Effectiveness of a short cognitive-behavioural treatment model . Acta Psychiatr Scand.1997;96: 14-24 .
17.
Kroenke K. , Swindle R.Cognitive-behavioral therapy for somatization and symptom syndromes: A critical review of controlled clinical trials . Psychother Psychosom . 2000; 69: 205-215 .
18.
Spiess JL , Northcott CJ , Offsay JD , Crossett JHPalliative care: something else we can do for our patients . Psychiatr Serv. 2002;53: 1525-1256 , 1529 .
Fink P. , Rosendal M. , Olesen F.Classification of somatization and functional somatic symptoms in primary care . Aust N Z J Psychiatry. 2005;39: 772-781 .
21.
de Waal MW , Arnold IA , Eekhof JA , van Hemert AMSomatoform disorders in general practice: prevalence, functional impairment and co-morbidity with anxiety and depressive disorders . Br J Psychiatry.2004;184: 470-476 .
22.
Toft T. , Fink P. , Oernboel E. , Christensen K. , Frostholm L. , Olesen F.Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the functional illness in primary care (FIP) study . Psychol Med.2005;35: 1175-1184 .
23.
Rief W. , Barsky AJPsychobiological perspectives on somatoform disorders . Psychoneuroendocrinology . 2005;30: 996-1002 .
24.
Hakala M. , Karlsson H. , Ruotsalainen U. , et al. Severe somatization in women is associated with altered brain metabolism . Psychol Med.2002;32: 1379-1385 .
25.
Hakala M. , Karlsson H. , Kurki T. , et al. Volumes of the caudate nuclei in women with somatization disorder and healthy women . Psychiatry Res.2004;131: 71-78 .
26.
Rauch SL , Phillips KA , Segal E. , et al. A preliminary morphometric magnetic resonance imaging study of regional brain volumes in body dysmorphic disorder . Psychiatry Res.2003;122: 13-19 .
27.
Streltzer J. , Eliashof BA , Kline AE , Goebert D.Chronic pain disorder following physical injury . Psychosomatics. 2000;41: 227-234 .
28.
Wambach S. , Rohr P. , Hauser W.Abuse of opioid therapy in somatoform pain disorder. A contribution from a psychosomatic/pain therapist point of view to the discussion of the indication of opioids in non-malignant pain based on 8 cases . Schmerz . 2001;15: 254-264 .
29.
Hansen GR , Streltzer J.The psychology of pain . Emerg Med Clin N Am. 2005;23: 339-348 .
30.
Servan-Schreiber D. , Tabas G. , Kolb NRSomatizing patients: Part II. Practical management . Am Fam Physician. 2000;61: 1423-8 , 1431-1432 .
