1995 Volume 35 Issue 4 Pages 287-297
In the department of psychosomatic medicine, Kyushu University, a chronic pain patient is defined as "a patient whose pain complaint or social or occupational impairment is in excess of what would be expected from the underlying organic pathology." We have treated patients of this category by means of various kinds of somatic, psychologic and psychiatric methods. In this paper, 40 cases who had been treated for chronic pain on an inpatient basis in our institute were studied regarding applied treatment methods, their effect, treatment outcome and factors affecting prognosis. The results are as follows : 1) All the subjects were prescribed several kinds of antidepressants and minor tranquilizers as pharmacological treatment with the aim of alleviating the pain. 2) The somatic approach consisted of nerve block, laser and silver spike point electro therapy, all of which were applied to the patients with neurogenic pain. We feel that these methods also have some psychological effect. 3) Some behavioral methods were applied, such as autogenic training (AT), graded exercise quota and other operant techniques (time-out, prompting and token economy). AT helped the patients to effectively cope with pain caused by depressive disorders and psychophysiological mechanisms. Graded exercise quota was applied to teach patients to effectively manage avoidance pain behaviors to fearful situations. Other operant techniques were necessary for controlling more excessive pain behaviors. 4) In addition, some patients received either family therapy or counseling. The former was effective both for patients with depressive disorders whose family system acted as a psychological burden and for patients with conversion disorders who utilized their pain as a communication method. Counseling was necessitated for patients whose interpersonal cognitions were distorted or whose social skills were immature. 5) Treatment outcomes were evaluated from following four aspects; the strength of the subjective pain, the degree of the impairment of daily activity or role functioning and the dependence on medical treatments. Evaluation of the short-term outcome at 1-month after discharge showed 3 excellent, 14 good, 19 fair and 4 poor cases. Evaluation of the long-term outcome at 6-12 months revealed 5 excellent, 18 good, 10 fair and 7 poor cases. 6) Examination of factors affecting prognosis suggested that the most important was to analyse the patients' pain problems from a detailed multiphasic view and to institute the appropriate treatment on the basis of that analysis. On the basis of these results, the possibility was discussed as to how to apply various methods systemically, such as somatic approach, pharmacological treatment, behavioral therapy, family therapy and other psychotherapy, depending on the patients' pathogenesis.
