Abstract
The onset and exacerbation of pain are affected by psychosocial factors as well as physical factors. As secondary responses to pain, anxiety and depression can occur, and pain may be expressed as one of manifestations of a mental disorder. In addition, chronic pain may reflect hardship in life. Therefore, the assessment and treatment of pain require biopsychosocial approaches. Therapists need to mobilize a variety of therapeutic modalities such as psychopharmacotherapy, relaxation therapy, and cognitive behavioral therapy. It is more effective to administer analgesics at fixed regular times than as needed (prn). It is dangerous to use a placebo in order to differentiate between organic and functional pain. In particular, treatment of patients with chronic pain requires multidisciplinary and integrative approach. It is desirable for therapists to focus on rehabilitation rather than on cure as a therapeutic goal for patients with chronic pain. Special therapeutic techniques are required for treatment of pain, because patients’ denial of psychological problems is likely to develop resistance to psychological approach.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Guggenheim FG, Smith GR. Somatoform disorders. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 6th ed. Baltimore: Williams & Wilkins; 1995.
American Psychiatric Association (APA). Statistical and diagnostic manual of mental disorders. 5th ed. Washington, DC: Am Psychiatric Publishing; 2013.
Sadock BJ, Sadock VA. Synopsis of psychiatry – behavioral sciences/clinical psychiatry. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 643–60.
Ford CV. The somatizing disorders: illness as a way of life. New York: Elsevier Biomedical; 1984. p. 98–126.
Leigh H, Reiser MF. The patient: biological, psychological and social dimensions of medical practice. 2nd ed. New York: Plenum Medical Book; 1985. p. 209–40.
Kaplan HI, Sadock BJ. Synopsis of psychiatry: behavioral sciences & clinical psychiatry. 7th ed. Baltimore: Williams & Wilkins; 1994. p. 628–30, 764–5
Bouckoms A, Hackett TP. The pain patient: evaluation and treatment. In: Cassem NH, editor. MGH handbook of general hospital psychiatry. 3rd ed. St. Louis: Mosby Year Book; 1991.
Reich J, Tupin J, Abramowitz S. Psychiatric diagnosis of chronic pain patients. Am J Psychiatry. 1983;140:1495–8.
von Knorring L. The experience of pain in depressed patients. Neuropsychobiology. 1975;1:155–65.
Blumer D, Heilbronn M. Chronic pain as a variant of depressive disease. J Nerv Ment Dis. 1982;170:381–406.
Sternbach RA. Pain: a psychophysiological analysis. New York: Academic; 1968.
Ulrich RE, Hutchinson RR, Azrin NH. Pain-elicited aggression. Psychol Rev. 1965;15:111–26.
Lynn R, Eysenck HJ. Tolerance for pain, extraversion, and neuroticism. Percept Motor Skills. 1961;12:161–2.
Kanfer FH, Goldfoot DA. Self-control and tolerance of noxious stimulation. Psychol Rev. 1966;18:79–85.
Engel GL. Psychogenic pain and the pain-prone patient. Am J Med. 1959;36:899–918.
Woodrow KM, Friedman CD, Sielgelaub AB. Pain tolerance: differences according to age, sex, and race. Psychosom Med. 1972;34:548–56.
Bond MR. The relation of pain to the Eysenck personality inventory, Cornell medical index, and Whitely index of hypochondria. Br J Psychiatry. 1971;119:671.
Robinson H, Kirk RF, Frye RF. A psychological study of patients with rheumatoid arthritis and other painful diseases. J Psychosom Res. 1972;16:53–6.
Pinsky JJ. Chronic, intractable, benign pain: a syndrome and its treatment with intensive short-term group psychotherapy. J Hum Stress. 1978;4:1721.
Blumetti AE, Modesti LM. Psychological predictors of success or failure of surgical intervention for intractable back pain. In: Bonica JJ, Albe-Fessard D, editors. Advances in pain research and therapy, vol. 2. New York: Raven Press; 1976.
Strassberg DS, Reimherr F, Ward M, et al. The MMPI and chronic pain. J Consult Clin Psychol. 1981;49:220–6.
Sternbach RA, Wolf SR, Murphy RW, et al. Traits of pain patients: the low-back ‘loser.’. Psychosomatics. 1973;14:226–9.
Timmermans G, Sternbach RA. Factors of human chronic pain: an analysis of personality and pain reaction variables. Science. 1974;184:806–8.
Blazer DG. Narcissism and the development of chronic pain. Int J Psychiatry Med. 1980;10:69–79.
Houpt JL. Chronic pain management. In: Soudemire A, Fogel BS, editors. Principles of medical psychiatry. Orlando: Grune & Stratton; 1987.
Postone N. Alexithymia in chronic pain patients. Gen Hosp Psychiatry. 1986;8:163–7.
Bradley JJ. Severe localized pain associated with the depression syndrome. Br J Psychiatry. 1963;109:741–5.
Lyndsay P, Wyckoff M. The depression-pain syndrome and its response to antidepressants. Psychosomatics. 1981;22:571–3.
Antczak-Bouckoms A, Bouckoms AJ. Affective disturbances and denial of problems in dental patients with pain. Int J Psychosom. 1985;32:9–11.
Davis GC, Bucsbuum MS, Bunney WE. Analgesia to painful stimuli in affective illness. Am J Psychiatry. 1979;136:1148.
Kim JC, Kim MJ. Pain threshold in major depressive disorder. J Korean Neuropsychiatr Assoc. 1985;24:227–35.
Magni G. The use of antidepressants in the treatment of chronic pain: a review of the current evidence. Drugs. 1991;42:730–48.
Pilowsky I. Pain as abnormal illness behavior. J Hum Stress. 1978;4:22–7.
Twycross RG, Lack SA. Therapeutics in terminal cancer. London: Pitman Publishing; 1984.
Beaver WT. Management of cancer pain with parenteral medication. J Am Med Assoc. 1980;244:2653–7.
Onghena P, Van Houdenlove B. Antidepressant induced analgesic in chronic nonmalignant pain: a meta-analysis of 39 placebo controlled studies. Pain. 1992;29:205–19.
Moore DP. Treatment of chronic pain with tricyclic antidepressants. South Med J. 1980;73:1585–6.
Ketterer MW. Cognitive/behavioral therapy of anxiety in the medically ill: cardiac settings. Semin Clin Neuropsychiatry. 1999;4:148–53.
McQuay HJ, Moore RA. Antidepressants and chronic pain. Br Med J. 1997;341:763–4.
Goldberg RJ, Sokol MS, Cullen LO. Acute pain management. In: Soudemire A, Fogel BS, editors. Principles of medical psychiatry. Orlando: Grune & Stratton; 1987.
Rull JA, Quibrera R, Gonzalez-Millan H. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia. 1969;5:215–8.
Houtchens MK, Richert JR, Sami A. Open label gabapentin treatment for pain in multiple sclerosis. Mult Scler. 1997;3:250–3.
Sist TC, Filadora VA, Miner M. Experience with gabapentin for neuropathic pain in the head and neck: report of ten cases. Reg Anesth. 1997;22:473–8.
Beecher HK. The powerful placebo. J Am Med Assoc. 1955;159:1602–6.
Levine JD, Gordon NC, Fields HL. The mechanism of placebo analgesia. Lancet. 1978;2:654–7.
Shapiro AK. Attitudes toward the use of placebos in treatment. J Nerv Ment Dis. 1960;130:200–11.
DeVaul RA, Zisook S. Chronic pain: the psychiatrist’s role. Psychosomatics. 1978;19:417–21.
Fordyce WE. In: Sternbach RA, editor. Learning processes in pain. New York: Raven Press; 1978.
Keefe FJ, Bradley LA. Behavioral and psychological approaches to the assessment and treatment of chronic pain. Gen Hosp Psychiatry. 1984;6:49–54.
Budzynski T. Biofeedback in the treatment of muscle contraction headache. Biofeedback Self Regul. 1978;3:409–35.
Blanchard EB, Andrasik F. Psychological assessment and treatment of headache: recent development and emerging issues. J Consult Clin Psychol. 1982;50:859–79.
Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Bantam Dell; 2013.
Schmid S, Grossman P, Schwarzer B, et al. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain. 2011;52:361–9.
Wong SY, Chan FW, Wong RL, et al. Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial. Clin J Pain. 2011;27:724–34.
Fordyce WE, Fowler US, Lehman JR. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil. 1973;54:399–408.
Bernardy K, Klose P, Busch AJ, et al. Cognitive behavioral therapies for fibromyalgia. Cochrane Database Syst Rev. 2013;9:CD009796. https://doi.org/10.1002/14651858.CD009796.pub2.
Monticone M, Cedraschi C, Ambrosini E, et al. Cognitive-behavioral treatment for subacute and chronic neck pain. Cochrane Database Syst Rev. 2015;5:CD010664. https://doi.org/10.1002/14651858.CD010664.pub2.
Jensen KB, Kosek E, Wicksell R, et al. Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain. 2012;153:1495–503.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Koh, K.B. (2018). Approach to Chronic Pain. In: Stress and Somatic Symptoms. Springer, Cham. https://doi.org/10.1007/978-3-030-02783-4_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-02783-4_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-02782-7
Online ISBN: 978-3-030-02783-4
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)