Clinical Experience of Treatments for Chronic Pain : A retrospective analysis of our therapeutic methods and results

Abstract

We had recently reported 40 patients who were chronically annoyed with pain, together with analyses of their physical conditions and psychological backgrounds. They had been divided into 3 groups : namely those who found responsible organic lesions (group A) , those who had indifferent organic lesions (group B) and those who found no organic lesions (group O . Results had shown their neurotic tendencies and mostly poor rationalizations regardless of the existence of organic lesions. As an additional report, this study was undertaken to evaluate and compare relative benefits of various therapeutic methods (both physical and mental)which were actually performed in 37 chronic pain patients (average age : 42 years, mean pain duration : 27 months)between 1989 and 1995. Nerve blocks were the first choice for all patients in group A (11 patients) , spinal cord stimulation was added in 6 patients and neurosurgical procedures were performed in 3 patients as physical treatments. Psychological therapies of group A consisted of Balint therapy in 6 and Operant technique in 5 patients. In group B and C (26 patients) , physical managements were aimed at the regression of myofascial pains. Among each multimodal treatments, physical therapy was mainly performed in 9 patients, exercise quotas in 6,Iow power laser in 6,nerve blocks in 3 and medication only in 2 patients. Psychosomatic approaches of group B and C were as follows : behavioral therapy (combination of EMGbiofeedback and muscle relaxation technique) in 15 patients, Morita therapy for outpatient in 5,Balint therapy in 3 and Operant technique also in 3 patients. Evaluation period for the efficacy of these treatments was, on the average, 15 months. Four patients resulted in marked improvement, 20 patients in improvement, 8 patients in no improvement and 5 patients failed to complete their programs. These results suggested that multimodal therapies listed above, covered from physical to mental problems, have certain clinical good effects in the course of chronic pain patients, even if they have apparent organic causes or they have actual psychological problems with poor body findings. Non effective patients have revealed poor patient-therapist relationship which could be the cause of unsuccessfulness of these treatments.