Psychological and Psychosocial Evaluation of the Chronic Pain Patient

  • Raphael J. Leo
  • Wendy J. Quinton
  • Michael H. Ebert


Pain is among the most common and disabling chronic health problems in the United States (Health United States 2006). The ubiquity of chronic, non-malignant pain and the complexities encountered with its management have prompted efforts to establish theoretical models to unveil, and otherwise explicate, factors other than those which are purely physical/sensory that contribute to the perception of pain and its associated impairments. One such model, the biopsychosocial model (Engel 1980), has gained significant appeal, emphasizing the bidirectional influences of psychological states and social/environmental factors with medical disorders and their associated symptoms, including pain. Rather than dichotomizing between physical and psychological origins, the biopsychosocial perspective maintains that the experience of pain, one’s presentation, and response to treatment are determined by the interaction of biological factors, the patient’s psychological makeup, the presence of psychological comorbidities, and the extent of social support and extenuating environmental circumstances (Gallagher 1999, Leo 2007).


Chronic Pain Irritable Bowel Syndrome Diabetic Neuropathy Trigeminal Neuralgia Interstitial Cystitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Alaranta H, Rytokoski U, Rissanen A, et al. Intensive physical and psychosocial training program for patients with chronic low back pain. A controlled clinical trial. Spine 1994;19(12):1339–49.Google Scholar
  2. Albert H. Psychosomatic group treatment helps women with chronic pelvic pain. J Psychosom Obstet Gynaecol. 1999;20:216–25.PubMedGoogle Scholar
  3. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  4. Andrasik F. What does the evidence show? Efficacy of behavioural treatments for recurrent headaches in adults. Neurol Sci. 2007;28(Suppl 2):70–7.Google Scholar
  5. Ansari A. The efficacy of newer antidepressants in the treatment of chronic pain: a review of current literature. Harv Rev Psychiatry. 2000;7:257–77.PubMedGoogle Scholar
  6. Arnold LM, Keck PE, Welge JA. Antidepressant treatment of fibromyalgia. A meta-analysis and review. Psychosomatics 2000;41(2):104–13.Google Scholar
  7. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47(10):930–7.PubMedGoogle Scholar
  8. Astin JA, Beckner W, Soeken K, Hochberg MC, Berman B. Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheum. 2002;47:291–302.PubMedGoogle Scholar
  9. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–45.PubMedGoogle Scholar
  10. Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: a diathesis–stress framework. Psychol Bull. 1996;119:95–10.Google Scholar
  11. Bartusch SL, Sanders BJ, D’Alessio JG, Jernigan JR. Clonazepam for the treatment of lancinating phantom limb pain. Clin J Pain 1996;12(1):59–62.PubMedGoogle Scholar
  12. Bendtsen L, Jensen R. Mirtazapine is effective in the prophylactic treatment of chronic tension-type headache. Neurology 2004;62(10):1706–11.PubMedGoogle Scholar
  13. Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol. 2001;13(12):1009–23.PubMedGoogle Scholar
  14. Blanchard EB. A critical review of cognitive, behavioral, and cognitive-behavioral therapies for irritable bowel syndrome. J Cogn Psychother. 2005;19(2):101–23.Google Scholar
  15. Bouckoms AJ, Litman RE. Clonazepam in the treatment of neuralgic pain syndrome. Psychosomatics 1985;26:933–936.PubMedGoogle Scholar
  16. Bradley LA, McKendree-Smith NL, Cianfrini LR. Cognitive-behavioral therapy interventions for pain associated with chronic illnesses. Sem Pain Med. 2003;1(2):44–54.Google Scholar
  17. Breslau N, Davis GC. Migraine, physical health and psychiatric disorder: a prospective epidemiology study in young adults. J Psychiatr Res. 1993;27:211–21.PubMedGoogle Scholar
  18. Brown DG, Krupp JJ. N-Methyl-D-aspartate receptor (NMDA) antagonists as potential pain therapeutics. Curr Top Med Chem. 2006;6(8):749–70.PubMedGoogle Scholar
  19. Brown RL, Patterson JJ, Rounds LA, Papasouliotis O. Substance abuse among patients with chronic back pain. J Fam Pract. 1996;43(2):152–60.PubMedGoogle Scholar
  20. Burns JW, Johnson BJ, Mahoney N, Devine J, Pawl R. Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain. J Consult Clin Psychol. 1998;66(2):434–9.PubMedGoogle Scholar
  21. Campbell JK, Penzien DB, Wall EM. Evidenced-based guidelines for migraine headache: behavioral and physical treatments. The US Headache Consortium. Available at: Accessed May 2009.
  22. Chaiken DC, Blaivas JG, Blaivas ST. Behavioral therapy for the treatment of refractory interstitial cystitis. J Urol. 1993;149:1445–8.PubMedGoogle Scholar
  23. Chandramouli J. Newer anticonvulsant drugs in neuropathic pain and bipolar disorder. J Pain Palliat Care Pharmacother. 2002;16(4):19–37.PubMedGoogle Scholar
  24. Chang G, Chen L, Mao J. Opioid tolerance and hyperalgesia. Med Clin North Am. 2007;91(2):199–211.PubMedGoogle Scholar
  25. Chong MS, Smith TE. Anticonvulsants for the management of pain. Pain Rev. 2000;7:129–49.Google Scholar
  26. Ciccone DS, Just N, Bandilla EB, Reimer E, Ilbeigi MS, Wu W. Psychological correlates of opioid use in patients with chronic nonmalignant pain: a preliminary test of the downhill spiral hypothesis. J Pain Symptom Manage. 2000;20(3):180–92.PubMedGoogle Scholar
  27. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–38.PubMedGoogle Scholar
  28. Cohen H, Neumann L, Haiman Y, Matar MA, Press J, Buskila D. Prevalence of post-traumatic stress disorder in fibromyalgia patients: overlapping syndromes or post-traumatic fibromyalgia syndrome? Semin Arthritis Rheum. 2002;32(1):38–50.PubMedGoogle Scholar
  29. Cohen MJM, Menefee LA, Doghramji K, et al. Sleep in chronic pain: problems and treatments. Int Rev Psychiatry. 2000;12:115–26.Google Scholar
  30. Collins SL, Moore RA, McQuay HJ, Wiffen P. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage. 2000;20(6):449–58.PubMedGoogle Scholar
  31. Crofford LJ, Rowbotham MC, Mease PJ, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52(4):1264–73.PubMedGoogle Scholar
  32. Dellemijn PL, Fields HL. Do benzodiazepines have a role in chronic pain management? Pain 1994;57:137–52.PubMedGoogle Scholar
  33. Derakshan N, Eysenck MW. Interpretive biases for one’s own behavior and physiology in high-trait-anxious individuals and repressors. J Pers Soc Psychol. 1997;73:816–25.Google Scholar
  34. Dersh J, Polatin PB, Gatchel RJ. Chronic pain and psychopathology: research findings and theoretical considerations. Psychosom Med. 2002;64:773–86.PubMedGoogle Scholar
  35. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment. Meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.PubMedGoogle Scholar
  36. Doverty M, White JM, Somogyi AA, Bochner F, Ali R, Ling W. Hyperalgesic responses in methadone maintenance patients. Pain 2001;90(1–2):91–6.PubMedGoogle Scholar
  37. Duman RS, Monteggia LM. A neurotrophic model for stress-related mood disorders. Biol Psychiatry. 2006;59:1116–27.PubMedGoogle Scholar
  38. Dunbar SA, Katz NP. Chronic opioid therapy for nonmalignant pain in patients with a history of substance abuse: report of 20 cases. J Pain Symptom Manage. 1996;11(3):163–71.PubMedGoogle Scholar
  39. Duric V, McCarson KE. Hippocampal neurokinin-1 receptor and brain-derived neurotrophic factor gene expression is decreased in rat models of pain and stress. Neuroscience 2005;133:999–1006.PubMedGoogle Scholar
  40. Dworkin SF, Turner JA, Mancl, L, et al. A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. J Orofac Pain. 2002;16(4):259–76.PubMedGoogle Scholar
  41. Dworkin SF, Turner JA, Wilson L, et al. Brief group cognitive-behavioral intervention for temporomandibular disorders. Pain 1994;59(2):175–87.PubMedGoogle Scholar
  42. Ehde DM, Jensen MP. Feasibility of a cognitive restructuring intervention for treatment of chronic pain in persons with disabilities. Rehabil Psychol. 2004;49(3):254–8.Google Scholar
  43. Eide PK, Jorum E, Stubhaug A, Bremnes J, Breivik H. Relief of post-herpetic neuralgia with the N-methyl-aspartic acid receptor antagonist ketamine: a double-blind cross-over comparison with morphine and placebo. Pain 1994;58(3):347–54.PubMedGoogle Scholar
  44. Eisenberg E, Kleiser A, Dotort A, et al. The NMDA (N-methyl-D-aspartate) receptor antagonist memantine in the treatment of postherpetic neuralgia: a double-blind, placebo-controlled study. Eur J Pain. 1998;2:321–7.PubMedGoogle Scholar
  45. Enarson MC, Hays H, Woodroffe MA. Clinical experience with oral ketamine. J Pain Symptom Manage. 1999;17:384–6.PubMedGoogle Scholar
  46. Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137:535–44.PubMedGoogle Scholar
  47. Evans S, Fishman B, Spielman L, Haley A. Randomized trial of cognitive behavior therapy versus supportive psychotherapy for HIV-related peripheral neuropathic pain. Psychosomatics 2003; 44:44–50.PubMedGoogle Scholar
  48. Farquhar CM, Rogers V, Franks S, Pearce S, Wadsworth J, Beard, RW. A randomized controlled trial of medroxyprogesterone acetate and psychotherapy for the treatment of pelvic congestion. Br J Obstet Gynaecol. 1989;96:1153–62.PubMedGoogle Scholar
  49. Fields HL, Basbaum AI. Central nervous system mechanisms of pain modulation, In: Wall PD, Melzack R, editors. Textbook of pain. 4th ed. Edinburgh: Churchill Livingstone; 1999. pp. 309–29.Google Scholar
  50. Fishbain DA, Cutler R, Rosomoff H. Comorbid psychiatric disorders in chronic pain patients. Pain Clin 1998;11:79–87.Google Scholar
  51. Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS. Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997;13:116–37.PubMedGoogle Scholar
  52. Fishbain DA, Cutler RB, Lewis J, Cole B, Rosomoff RS, Rosomoff HL. Do the second-generation “atypical neuroleptics” have analgesic properties? A structured evidence-based review. Pain Med. 2004;5(4):359–65.PubMedGoogle Scholar
  53. Fishbain DA. Approaches to treatment decisions for psychiatric comorbidity in the management of the chronic pain patient. Med Clin North Am. 1999;83:737–60.PubMedGoogle Scholar
  54. Fisher K, Coderre TJ, Hagen NA. Targeting the N-methyl-D-aspartate receptor for chronic pain management: preclinical animal studies, recent clinical experience and future research directions. J Pain Symptom Manage. 2000;20(5):358–73.PubMedGoogle Scholar
  55. Forseth KO, Husby G, Gran JT, Forre O. Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. A prospective study. J Rheumatol. 1999;26(11):2458–67.PubMedGoogle Scholar
  56. Frampton JE, Scott LJ. Pregabalin in the treatment of painful diabetic neuropathy. Drugs 2004;64(24):2813–20.PubMedGoogle Scholar
  57. Galer BS. Neuropathic pain of peripheral origin: advances in pharmacologic treatment. Neurology 1995;45(suppl 9):17–25.Google Scholar
  58. Gallagher RM. Treatment planning in pain medicine – integrating medical, physical, and behavioral therapies. Med Clin North Am. 1999;83(3):823–49.PubMedGoogle Scholar
  59. Gatchel RJ. Early development of physical and mental deconditioning in painful spinal disorders. In: Mayer TG, Mooney V, Gatchel RJ, editors. Contemporary conservative care for painful spinal disorders. Philadelphia, PA: Lea & Febiger; 1991. pp. 278–89.Google Scholar
  60. Gerner P, Mujtaba M, Sinnott CJ, Wang GK. Amitriptyline versus bupivacaine in rat sciatic nerve blockade. Anesthesiology 2001;94(4):661–7.PubMedGoogle Scholar
  61. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292(19):2388–95.PubMedGoogle Scholar
  62. Gomez-Perez FJ, Rull JA, Dies H, Rodriquez-Rivera JG, Gonzalez-Barranco J, Lozano-Castaneda O. Nortriptyline and fluphenazine in the symptomatic treatment of diabetic neuropathy: a double-blind cross-over study. Pain 1985;23(4):395–400.PubMedGoogle Scholar
  63. Gonul AS, Akdeniz F, Taneli F, Donat O, Eker C, Vahip S. Effect of treatment on serum brain-derived neurotrophic factor levels in depressed patients. Eur Arch Psychiatry Clin Neurosci. 2005;255:381–6.PubMedGoogle Scholar
  64. Guay DR. Oxcarbazepine, topiramate, zonisamide, and levetiracetam: potential use in neuropathic pain. Am J Geriatr Pharmacother. 2003;1(1):18–37.PubMedGoogle Scholar
  65. Gureje O, Von Korff M, Kola L, et al. The relation between multiple pains and mental disorders: results from the World Mental Health Surveys. Pain 2008;135(1–2):82–91.PubMedGoogle Scholar
  66. Hagglund KJ, Haley WE, Reveille JD, Alarcon GS. Predicting individual differences in pain and functional impairment among patients with rheumatoid arthritis. Arthritis Rheum. 1989;32:851–8.PubMedGoogle Scholar
  67. Hathaway SR, McKinley JC, Butcher JN, et al. Minnesota multiphasic personality inventory-2: manual for administration. Minneapolis, MN: University of Minnesota Press; 1989.Google Scholar
  68. Haythornthwaite JA, Sieber WJ, Kerns RD. Depression and the chronic pain experience. Pain 1991;46:177–84.PubMedGoogle Scholar
  69. Health United States, 2006 with chartbook on trends in the health of Americans. Hyattsville, MD: National Centers for Health Statistics; 2006. pp. 116–24.Google Scholar
  70. Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010;(7):CD002014. DOI: 10.1002/14651858.CD002014.pub3. Available from
  71. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1–9.PubMedGoogle Scholar
  72. Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC. Partial night sleep deprivation reduces natural killer and cellular immune response in humans. FASEB J. 1996;10(5):643–53.PubMedGoogle Scholar
  73. Ives TJ, Chelminski PR, Hammett-Stabler CA, et al. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv Res. 2006;6:46.PubMedGoogle Scholar
  74. Jackson JL, O’Malley PG, Tomkins G, Balden E, Santoro J, Kroenke K. Treatment of functional gastrointestinal disorders with antidepressant medications: a meta-analysis. Am J Med. 2000;108:65–72.PubMedGoogle Scholar
  75. Jensen MP, Karoly P, Huger R. The development and preliminary validation of an instrument to assess patients’ attitudes toward pain. J Psychosom Res. 1987;31(3):393–400.PubMedGoogle Scholar
  76. Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R, editors. Handbook of pain assessment. 2nd ed. New York, NY: The Guilford Press; 2001. pp. 15–34.Google Scholar
  77. Jensen MP, Turner JA, Romano JM, Karoly P. Coping with chronic pain: a critical review of the literature. Pain 1991;47:249–83.PubMedGoogle Scholar
  78. Katerndahl D. Panic plaques: panic disorder & coronary artery disease in patients with chest pain. J Am Board Fam Pract. 2004;17(2):114–26.PubMedGoogle Scholar
  79. Kawasaki Y, Kumamoto E, Furue H, Yoshimura M. Alpha 2 adrenoceptor-mediated presynaptic inhibition of primary afferent glutamatergic transmission in rat substantia gelatinosa neurons. Anesthesiology 2003;98:682–9.PubMedGoogle Scholar
  80. Keefe FJ, Abernethy AP, Campbell LC. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–30.PubMedGoogle Scholar
  81. Kelada E, Jones A. Interstitial cystitis. Arch Gynecol Obstet. 2007;275(4):223–9.PubMedGoogle Scholar
  82. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23(4):345–56.PubMedGoogle Scholar
  83. Khojainova N, Santiago-Palma J, Kornick C, Breitbart W, Gonzales GR. Olanzapine in the management of cancer pain. J Pain Symptom Manage. 2002;23(4):346–50.PubMedGoogle Scholar
  84. Khoromi S, Patsalides A, Parada S, Salehi V, Meegan JM, Max MB. Topiramate in chronic lumbar radicular pain. J Pain. 2005;6(12):829–36.PubMedGoogle Scholar
  85. King T, Gardell LR, Wang R, et al. Role of NK-1 neurotransmission in opioid-induced hyperalgesia. Pain 2005;116(3):276–88.PubMedGoogle Scholar
  86. Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev. 2007;11(3):163–78.PubMedGoogle Scholar
  87. Koenig TW, Clark MR. Advances in comprehensive pain management. Psychiatr Clin North Am. 1996;19:589–611.PubMedGoogle Scholar
  88. Lackner JM, Lou Coad M, Mertz HR, et al. Cognitive therapy for irritable bowel syndrome is associated with reduced limbic activity, GI symptoms, and anxiety. Behav Res Ther. 2006;44(5):621–38.PubMedGoogle Scholar
  89. Lackner JM, Quigley BM. Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome. Behav Res Ther. 2005;43:943–57.PubMedGoogle Scholar
  90. Larijani GE, Goldberg ME, Hojat M, Khaleghi B, Dunn JB, Marr AT. Modafinil improves recovery after general anesthesia. Anesth Analg. 2004;98(4):976–81.PubMedGoogle Scholar
  91. Lee RL, Spencer PS. Effect of tricyclic antidepressants on analgesic activity in laboratory animals. Postgrad Med J. 1980;56(suppl 1):19–24.PubMedGoogle Scholar
  92. Leino P, Magni G. Depressive and distress symptoms as predictors of low back pain, neck–shoulder pain, and other musculoskeletal morbidity: a 10-year follow-up of metal industry employees. Pain 1993;53:89–94.PubMedGoogle Scholar
  93. Leo RJ, Narendran R. Anticonvulsant use in the treatment of bipolar disorder: a primer for primary care physicians. Primary Care Companion J Clin Psychiatry. 1999;1:74–84.PubMedGoogle Scholar
  94. Leo RJ. Treatment considerations in neuropathic pain. Curr Treat Options Neurol. 2006;8(5):389–400.PubMedGoogle Scholar
  95. Leo RJ. Clinical manual of pain management in psychiatry. Washington, DC: American Psychiatric Publishing, Incorporated; 2007.Google Scholar
  96. Lesbros-Pantoflickova D, Michetti P, Fried M, Beglinger C, Blum AL. Meta-analysis: the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;20:1253–69.PubMedGoogle Scholar
  97. Lin EHB, Katon W, Von Korff M, et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA 2003;290(18):2428–34.PubMedGoogle Scholar
  98. Loeser JD. Concepts of pain. In: Stanton-Hicks M, Boas R, eds. Chronic low back pain. New York, NY: Raven; 1982, pp. 145–48.Google Scholar
  99. Lynch ME. Antidepressants as analgesics: a review of randomized controlled trials. J Psychiatry Neurosci. 2001;26(1):30–6.PubMedGoogle Scholar
  100. Max MB, Lynch SA, Muir J, Shoaf SE, Smoller B, Dubner R. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med. 1992;326:1250–6.PubMedGoogle Scholar
  101. Max MB. Treatment of post-herpetic neuralgia: antidepressants. Ann Neurol. 1994;35(suppl):50–3.Google Scholar
  102. McQuay H, Carroll D, Jadad AR, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. Br Med J. 1995;311:1047–52.Google Scholar
  103. McQuay HJ, Tramer M, Nye BA, Carroll D, Wiffen PJ, Moore RA. A systematic review of antidepressants in neuropathic pain. Pain 1996;68:217–27.PubMedGoogle Scholar
  104. McQuay HJ. Neuropathic pain: evidence matters. Eur J Pain. 2002;6(suppl A):11–8.PubMedGoogle Scholar
  105. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain 2003;106:127–33.PubMedGoogle Scholar
  106. McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain 2004;111:77–83.PubMedGoogle Scholar
  107. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975;1:277–99.PubMedGoogle Scholar
  108. Melzack R. From the gate to the neuromatrix. Pain 1999;82(Suppl):S121–6.Google Scholar
  109. Mochizucki D. Serotonin and noradrenaline reuptake inhibitors in animal models of pain. Hum Psychopharmacol Clin Exp. 2004;19(suppl 1):15–9.Google Scholar
  110. Moldofsky H, Scarisbrick P. Introduction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation. Psychosom Med. 1976;38:35–44.PubMedGoogle Scholar
  111. Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5:387–98.Google Scholar
  112. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999;80:1–13.PubMedGoogle Scholar
  113. Nemmani KVS, Mogil JS. Serotonin–GABA interactions in the modulation of mu- and kappa-opioid analgesia. Neuropharmacology 2003;44:304–10.PubMedGoogle Scholar
  114. Nestler EJ, Barrot M, DiLeone RJ, Eisch AJ, Gold SJ, Monteggia LM. Neurobiology of depression. Neuron 2002;34(1):13–25.PubMedGoogle Scholar
  115. Neugebauer V, Li W, Bird GC, Han JS. The amygdala and persistent pain. Neuroscientist 2004;10(3):221–34.PubMedGoogle Scholar
  116. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA 1996;276(4):313–8.Google Scholar
  117. Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioral interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006;38(3):172–80.PubMedGoogle Scholar
  118. Novak V, Kanard R, Kissel JT, Mendell JR. Treatment of painful sensory neuropathy with tiagabine: a pilot study. Clin Auton Res. 2001;11(6):357–61.PubMedGoogle Scholar
  119. O’Malley PG, Balden E, Tomkins G, Santoro J, Kroenke K, Jackson JL. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med. 2000;15(9):659–66.PubMedGoogle Scholar
  120. Onghena P, Van Houdenhove B. Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebo-controlled studies. Pain 1992;49:205–19.PubMedGoogle Scholar
  121. Pappagallo M. Newer antiepileptic drugs: possible uses in the treatment of neuropathic pain and migraine. Clin Ther. 2003;25(10):2506–38.PubMedGoogle Scholar
  122. Parker J, Frank R, Beck N, et al. Pain in rheumatoid arthritis: relationship to demographic, medical, and psychological factors. J Rheumatol. 1988;15(3):433–7.PubMedGoogle Scholar
  123. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine—which goes first? Spine 1993;18(1):66–71.PubMedGoogle Scholar
  124. Raffa RB. Antihistamines as analgesics. J Clin Pharm Ther. 2001;26(2):81–85.PubMedGoogle Scholar
  125. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31.PubMedGoogle Scholar
  126. Reddy S. Patt RB. The benzodiazepines as adjuvant analgesics. J Pain Symptom Manage. 1994;9(8):510–4.PubMedGoogle Scholar
  127. Reissig JE, Rybarczyk AM. Pharmacologic treatment of opioid-induced sedation in chronic pain. Ann Pharmacother. 2005;39(4):727–31.PubMedGoogle Scholar
  128. Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol. 1998;41(2):422–35.PubMedGoogle Scholar
  129. Remillard G. Oxcarbazepine and intractable trigeminal neuralgia. Epilepsia 1994;35:528–9.Google Scholar
  130. Romano JM, Turner JA. Chronic pain and depression: does the evidence support a relationship? Psychol Bull. 1985;97:18–34.PubMedGoogle Scholar
  131. Rome HP Jr, Rome JD. Limbically augmented pain syndrome (LAPS): kindling, corticolimbic sensitization, and the convergence of affective and sensory symptoms in chronic pain disorders. Pain Med. 2000;1(1):7–23.PubMedGoogle Scholar
  132. Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 1983;17:33–44.PubMedGoogle Scholar
  133. Roy-Byrne PP, Davidson KW, Kessler RC, et al. Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry. 2008;30(3):208–25.PubMedGoogle Scholar
  134. Rumore MM, Schlichting DA. Clinical efficacy of antihistamines as analgesics. Pain 1986;25:7–22.PubMedGoogle Scholar
  135. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database of Syst Rev 2007;(4) Art No.: CD005454. doi:10.1002/14651858. CD005454.pub2.Google Scholar
  136. Samborski W, Lezanska-Szpera M, Rybakowski JK. Open trial of mirtazapine in patients with fibromyalgia. Pharmacopsychiatry 2004;37(4):168–70.PubMedGoogle Scholar
  137. Sanders SH. Operant therapy with pain patients: evidence for its effectiveness. In: Lebovits AH, editor. Seminars in pain medicine I. Philadelphia, PA: W.B. Saunders; 2003. pp. 90–8.Google Scholar
  138. Sang CN, Booher S, Gilron I, Parada S, Max MB. Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: efficacy and dose–response trials. Anesthesiology 2002;96(5):1053–61.PubMedGoogle Scholar
  139. Saper JR, Lake AE, Tepper SJ. Nefazodone for chronic daily headache prophylaxis: an open-label study. Headache 2001;41:465–74.PubMedGoogle Scholar
  140. Scheer SJ, Watanabe TK, Radack KL. Randomized controlled trials in industrial low back pain. Part 3. Subacute/chronic pain interventions. Arch Phys Med Rehabil. 1997;78(4): 414–23.PubMedGoogle Scholar
  141. Seidel S, Aigner M, Ossege M, Pernicka E, Wildner B, Sycha T. Antipsychotics for acute and chronic pain in adults. Cochrane Database Syst Rev. 2008;(4):CD004844. DOI: 10.1002/14651858.CD004844.pub2. Available from
  142. Semenchuk MR, Davis B. Efficacy of sustained-release bupropion in neuropathic pain: an open-label study. Clin J Pain. 2000;16:6–11.PubMedGoogle Scholar
  143. Sharav Y, Singer E, Schmidt E, Dionne RA, Dubner R. The analgesic effect of amitriptyline on chronic facial pain. Pain 1987;31(2):199–209.PubMedGoogle Scholar
  144. Silberstein SD, Young WB, Hopkins MM, et al. Olanzapine in the treatment of refractory migraine and chronic daily headache. Cephalalgia 2000;20:382–3.Google Scholar
  145. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 1999;83(3):389–400.PubMedGoogle Scholar
  146. Snow V, Weiss K, Wall EM, Mottur-Pilson C, American Academy of Family Physicians. Pharmacologic management of acute attacks of migraine and prevention of migraine headache. Ann Intern Med. 2002;137(10):840–9.PubMedGoogle Scholar
  147. Solaro C, Uccelli MM, Brichetto G, Gaspperini C, Mancardi G. Topiramate relieves idiopathic and symptomatic trigeminal neuralgia. J Pain Symptom Manage. 2001;21(5):367–8.PubMedGoogle Scholar
  148. Stones W, Cheong YC, Howard FM. Interventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev. 2007;4:CD000387.Google Scholar
  149. Sullivan MJ, Thorn B, Haythornthwaite JA, et al. Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain. 2001;17(1):52–64.PubMedGoogle Scholar
  150. Sussman N. SNRI’s versus SSRI’s: mechanisms of action in treating depression and painful physical symptoms. Primary Care Companion J Clin Psychiatry. 2003;5(suppl 7):19–26.Google Scholar
  151. Swartz KL, Pratt LA, Armenian HK, et al. Mental disorders and the incidence of migraine headaches in a community sample: results from the Baltimore Epidemiologic Catchment Area follow-up study. Arch Gen Psychiatry. 2000;57:945–50.PubMedGoogle Scholar
  152. Tait RC, Pollard CA, Margolis RB, Duckro PN. Krause SJ. The Pain Disability index: psychometric and validity data. Arch Phys Med Rehabil. 1987;68(7):438–41.PubMedGoogle Scholar
  153. Taiwo YO, Fabian A, Pazoles CJ, Fields HL. Potentiation of morphine antinociception by monoamine reuptake inhibitors in the rat spinal cord. Pain 1985;21(4):329–337.PubMedGoogle Scholar
  154. Tomkins GE, Jackson JL, O’Malley PG, Balden E, Santoro JE. Treatment of chronic headache with antidepressants: a meta-analysis. Am J Med. 2001;111:54–63.PubMedGoogle Scholar
  155. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678–90.PubMedGoogle Scholar
  156. Turner JA, Mancl L, Aaron LA. Brief cognitive-behavioral therapy for temporomandibular disorder pain: effects on daily electronic outcome and process measures. Pain 2005;117: 377–87.PubMedGoogle Scholar
  157. Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain 2006;121:181–94.PubMedGoogle Scholar
  158. van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFarlane A, Herman JL. Dissociation, somatization, and affect dysregulation: the complexity of adaptation to trauma. Am J Psychiatry. 1996;153(suppl 7):83–93.PubMedGoogle Scholar
  159. Van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomised, placebo-controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol. 2004;172(2):533–6.PubMedGoogle Scholar
  160. Vanderah TW, Suenaga NM, Ossipov MH, Malan TP Jr, Lai J, Porreca F. Tonic descending facilitation from the rostral ventromedial medulla mediates opioid-induced abnormal pain and antinociceptive tolerance. J Neurosci. 2001;21(1):279–86.PubMedGoogle Scholar
  161. Ventafridda V, Caraceni A, Saita L, et al. Trazodone for deafferentation pain: comparison with amitriptyline. Psychopharmacology (Berl) 1988;95(suppl):S44–9.Google Scholar
  162. Vinik A. Use of antiepileptic drugs in the treatment of chronic painful diabetic neuropathy. J Clin Endocrinol Metab. 2005;90(8):4936–45.PubMedGoogle Scholar
  163. Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006;60(7):341–8.PubMedGoogle Scholar
  164. Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62(3):363–72.PubMedGoogle Scholar
  165. Vlaeyen JWS. Chronic low back pain: assessment and treatment from a behavioral rehabilitation perspective. Amsterdam: Swets & Zeitlinger; 1991.Google Scholar
  166. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52(2):157–68.PubMedGoogle Scholar
  167. Ware JE Jr, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.PubMedGoogle Scholar
  168. Watkins LR, Hutchinson MR, Ledeboer A, Wieseler-Frank J, Milligan ED, Maier SF. Norman Cousins Lecture. Glia as the “bad guys”: implications for improving clinical pain control and the clinical utility of opioids. Brain Behav Immun. 2007;21(2):131–46.PubMedGoogle Scholar
  169. Webster DC, Brennan T. Use and effectiveness of psychological self-care strategies for interstitial cystitis. Health Care Women Int. 1995;16:463–75.PubMedGoogle Scholar
  170. Weissman MM, Markowitz JC, Klerman GL. Comprehensive guide to interpersonal psychotherapy. New York, NY: Basic Books; 2000.Google Scholar
  171. White, JM. Pleasure into pain: the consequences of long-term opioid use. Addict Behav. 2004;29(7):1311–24.PubMedGoogle Scholar
  172. Wiffen PJ, Collins S, McQuay HJ, Carroll D, Jadad A, Moore, RA. Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev. 2010;(1):CD001133. DOI: 10.1002/14651858.CD001133.pub3.Google Scholar
  173. Wiffen PJ, Rees J. Lamotrigine for acute and chronic pain. The Cochrane Collaboration, Cochrane Pain, Palliative and Supportive Care Group. 2009;1.Google Scholar
  174. Wu SM, Compton P, Bolus R, et al. The addiction behaviors checklist: validation of a new clinician-based measure of inappropriate opioid use in chronic pain. J Pain Symptom Manage. 2006;32(4):342–51.PubMedGoogle Scholar
  175. Xie JY, Herman DS, Stiller CO, et al. Cholecystokinin in the rostral ventromedial medulla mediates opioid-induced hyperalgesia and antinociceptive tolerance. J Neurosci. 2005;25(2):409–16.PubMedGoogle Scholar
  176. Yerby MS. Special considerations for women with epilepsy. Pharmacotherapy 2000; 2(suppl 8):159–70.Google Scholar
  177. Yokogawa F, Kiuchi Y, Ishikawa Y, et al. An investigation of monoamine receptors involved in antinociceptive effects of antidepressants. Anesth Analg. 2002;95(1):163–8.PubMedGoogle Scholar
  178. Young LD. Psychological factors in rheumatoid arthritis. J Consult Clin Psychol. 1992;60(4):619–27.PubMedGoogle Scholar
  179. Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens EL. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain 1997;73(2):223–30.PubMedGoogle Scholar
  180. Zenz M, Strumpf M, Tryba M. Long-term oral opioid therapy in patients with chronic nonmalignant pain. J Pain Symptom Manage. 1992;7(2):69–77.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Raphael J. Leo
    • 1
    • 2
  • Wendy J. Quinton
    • 3
  • Michael H. Ebert
    • 4
    • 5
  1. 1.Department of PsychiatrySchool of Medicine and Biomedical Sciences, State University of New York at BuffaloBuffaloUSA
  2. 2.Center for Comprehensive Multidisciplinary Pain Management, Erie County Medical CenterBuffaloUSA
  3. 3.Department of PsychologyState University of New York at BuffaloBuffaloUSA
  4. 4.Yale University School of MedicineNew HavenUSA
  5. 5.VA Connecticut Healthcare SystemNew HavenUSA

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