The relationship of chronic pain, mental illness and organic disorders.

One hundred and six consecutive new attenders at a regional pain relief clinic were assessed using ratings of pain, standardized psychiatric interviews and physical examination by independent assessors. Approximately half the subjects had diagnosed mental illness and two-thirds had diagnosed organic disease. Pain ratings were higher in those with mental illness but were not related to the presence of organic pathology. The distribution of mental illnesses was not related to the organic status and those without physical disease had the lowest ratings on psychiatric assessments. All major findings were confirmed at a follow-up assessment. There is no evidence that these subjects can be divided into a simple dichotomy of those with physical or mental illnesses, or that pain measures can discriminate between them. It is concluded that all chronic pain patients require both physical and mental state assessment.