Chronic failure in the treatment of chronic pain? The silent influence of the personality and its disorders

Patients with non-oncologic chronic pain conditions commonly present with psychiatric symptoms and disorders. In a sample of non-oncologic chronic pain patients referred for psychiatric consultation, personality disorders were found more frequently than any other diagnosis, including major depression. Borderline and narcissistic personality disorders were the most common psychiatric diagnoses in the group. This paper debates such findings along with a literature review carried out using the keywords chronic pain, borderline personality disorder, and narcissistic personality disorder. Diagnostic criteria for the personality disorders are shown, as well as some “soft signs” that may indicate the disorder. Two vignettes exemplify each of the personality disorders; finally, some recommendations are offered to ease the clinical management of such patients by multi-professional teams for chronic pain patients.