Chronic pain as a depressive equivalent

In some cases, chronic pain is due not to an organic cause but rather to psychologic factors. Among these, chronic pain as a depressive equivalent is particularly interesting. By this term, we mean a painful state caused by depression and manifesting itself almost entirely in this somatic form, thus making diagnosis difficult. There are, however, some features that may positively orient diagnosis: age at onset and sex, clinical history, presence of a subdepressive state, attitude during the medical examination, absence of delusions and hallucinations, and the Rorschach test pattern. These features permit correct differential diagnosis and justify pharmacologic therapy with antidepressants.