Emotion or emotional state is recognized as a state of mind deviating from a calm, intellectually controlled state of a person in response to external and/or internal stimuli. Emotion usually implies two conditions : a way of feeling and a way of acting (Papez). In other words, it means emotional experiences such as anger, anxiety or depression and emotional expressions or behaviors such , as palpitation, dilatation of pupil, sweating, running and clenching hands. Neuronal mechanisms of these two functions of emotions are not clear, especially neuronal connections of emotional experiences to emotional expressions or behaviors. It is well known that involuntary movements are usually influenced through emotional changes. Emotional effects on spasmodic torticollis were analysed by neurophysiological studies. The state of spasmodic torticollis were altered by somatic stimuli and also psychic tension. One third of the total cases showed enhancement of torticollis through psychic tension. As for the pharmacological effects on spasmodic torticollis, improvement was obtained in 9 out of 12 cases by diazepam, in 6 out of 7 by clonazepam and in 5 out of 12 by L-DOPA. In contrast to these findings, 10 out of 12 cases grew worse by haloperidol. β-adrenergic blocking agents were also effective for essential tremor and so forth. Recent advances made it clear that the involuntary movements were caused or enhanced through the actions of dopamine, acetylcholine, GABA, and so on known as neurotransmitters. From these facts mentioned above, it can be suggested that changes of emotion come to fire the neurotransmitters in the brain. This is very important for interpreting psychosomatic disorders. In the future, a pharmacological trial through influencing the neurotransmitters in the brain will bring a new trend to the treatment of psychosomatic disordcrs.

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Since the isolation of endogenous opioid peptides-enkephalins and endorphins-from brain tissue, the participation of these peptides in the mechanism of pain perception and analgesia has been suggested. The possible roles of these opioid peptides in the mechanism and the recent progress in this research field were reviewed from the clinical and experimental point of view.

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The psychiatrist who manages patients with chronic pain has two major roles ; psychiatric consultation and psychiatric treatment. The process and technique used in psychiatric consultations with chronic pain patients is discussed. When there has been a negative medical and surgical examination, it is the task of the psychiatrist to evaluate the patient for psychological components to his pain rather than to assume the existence of "psychogenic" pain. Accurate communication with. the referring physician about any psychiatric components, without premature judgment for the "cause of the pain, " is most important. Pain management programs based on the operant conditioning theory are more increasingly accepted in the treatment of patients with chronic pain. Utilizing a report on the first 200 patients treated at the Pain Management Center at Mayo Clinic, the content of a pain management program is discussed. Potential difficulties which might be encountered in the application of a pain management program in Japan are also discussed.

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In order to establish a structural model of pain, a multivariate statistical analysis was made in the patients whose chief complaint was pain. The subjects consisted of 59 patients who were out-patients of the pain clinic, Osaka Medical College. These patients were given the Questionnaire on Pain and the MAS test and, consequently, tlley were classified into 2 groups, that is 1) the acute pain group and 2) the chronic pain group. Chi-square test was conducted ragarding the numbers of each item counted and the input data were sccured of 30 variables which showed high significant levels. An analysis was made by ACOS-800 II. The results were summarized as follows : 1) When a principal component analysis was made according to the standard with the eigenvalue above 1.0,11 principal components were obtained. 2) A factor analysis was made by choosing 21 variables which were statistically significant out of the original 30 variables. A varimax rotation was conducted according to the standard with the eigenvalue above 2.0. As the result, 4 elements were obtained including 1) the site of pain, 2) pain reaction and a treatment technique directly related to the reaction, 3) the personality of the patients with pain and 4) the situation, the therapist-patient relationship and environmental factors. 3) Another structural analysis of about 100 cases of chronic pain patients was performed in the same method with the same conclusion arising. This result may support the reasonability of the theory model of pain.

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In this paper chronic headache was discussed from a psychosomatic standpoint. From 1970 to 1979,521 patients whose chief complaint was headache were seen at the Clinic of Psychosomatic Medicine and Neurological Medicine of Nagoya University Hospital. They consisted of 14. 1% of all the patients. Depressed patients with chronic headache were analized. Seventy-nine patients with mild depression visited our clinic from 1971 to 1974. Forty-three of them complained of headaches. These headaches were neither throbbing nor strong, and mostly located in the occipital region. The nature of these headaches were similar to that of muscle contraction headache. However, muscle relaxant agents are not so effective that it is better to classify this as depressive headache which is different from muscle contraction headache. EMG activities of the temporal muscle were measured in 18 patients with muscle contraction headache. The control group consisted of 30 persons of the hospital staff. The mean muscle tension of the patient group was 2.49 μV, which was higher than that of the control group (P<0.01). At the time of measurement 8 patients complained of headache and the remaing 10 did not. The mean level of the former group was 2.56 μV and that of the latter 2.44 μV. Statistical analysis showed no significant difference between these two groups (P<0.05). The mean EMG Ievel of patients who did not complain of headache during measurement were higher than that of the control group (P<0.01). In some patients, EMG activities were lower than the mean value of the control group. These results indicate that muscle contraction headache is caused not only by muscle tension but by other factors. The pain threshold is an important factor. Headache is one type of pain, so that it is conceivable that headache consists of two components, that is, 1) a process to induce "pain stimulus" and 2) a process to perceive "pain sensation". Psychological factors are related to the three phases of these processes, the first is a productive process of preliminary physical constitution of headache, the second is a trigger of the first occurrence of symptom, and the third a process of alteration in the pain threshold.

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Pathophysiologically, abdominal pain can be grouped into two categories : visceral pain and somatic pain. However, both afferent fibers, that is visceral afferent fibers (C-fiber) and somatic afferent fibers (A-fiber), which transmit pain impulses, enter the dorsal root of the spinal cord. The impulse of visceral pain is said to be induced by alteration in tone and motility of the alimentary canal, particular]y by spasm. Abdominal pains requiring psychosomatic treatment probably result from the same mechanism. In the last 5 years, there were 1933 paticnts who complained of abdominal pains in our department. The highest frequent location of abdominal pains in these patients was the central epigastric region, which was 50% of all the pains. The second highest was diffuse abdominal pain, which was 38%. Organic diseases were discovered by clinical examinations in 769 patients or 40% of the total subjects. The major final diagnoses included gastric ulcer, chronic gastritis, duodenal ulcer, gastric cancer and gall stone in the central epigastrium and right upper abdomen. However, in the left upper abdomen and left lower abdomen, irritable colon syndrome, which is a functional disturbance of the bowel, was found most frequently. During the same period, 106 patients visited our psychosomatic clinic, complaining abdominal pain. These abdominal pain were located mainly in the central epigastrium and diffuse abdomen. The most frequent diagnosis was irritable colon syndrome, which was followed by hysteria. Then there were patients with anxiety neurosis, depression or depressive state. From the etiological standpoint, patients had anxiety and tension most frequently, which was 42% of all the subjects. The second highest incidence was conversion reaction, namely psychogenic abdominal pain or hysterical pain, which was 35%. Finally, we measured the colonic intraluminal pressure in the patients with irritable colon syndrome. To measure the intraluminal pressure of the ascending colon and sigmoid colon at same time, we have divised a new method, an endoscopic retrograde bowel insertion method (ERBI). In the patients with spastic colon, intraluminal pressure of the sigmoid colon was much higher than that of the ascending colon, especially after prostigmine was injected.

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1) Chronic stiffness of the shoulder frequently shows long duration (seven years in average). Fibrositic conditions and psychosomatic factors are found more frequently in this disorder than in chronic low back pain. Therefore, a psychological approach is required in addition to the therapeutic exercise. 2) There are more cases of chronic low back pain who complain the vegetative syndrome as compared with the normal control. Therefore, emphasis should be given to the treatment of this complaint. Psychological evaluation is useful as previously stated (Takaguchi, 1968). 3) Apparently more patients of rheumatoid arthritis show depression than the normal control. Many of them show less mental subjective symptoms according to CMI. These facts are important when psychological rehabilitation is done for the patients of rheumatoid arthritis. 4) The skin temperature biofeedback program was conducted in a patient of traumatic cervical syndrome with a useful result. It was confirmed that muscular relaxation was attained with increased skin temperature. "Ultrasound+skin temperature biofeedback" was applied to a case of occupational local vibration disease (his main complaints were paresthesia of fingers and stiffness of shoulder). This procedure was proved to be an excellent method. 5) It was emphasized that there should be a more integrative psychological approach to the dysesthetic pain of patients with spinal cord injury.

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Any type of pain involves more or less mental problems. So the authors think that there is no therapy of pain unless the therapist cares his patients with enough understanding and insight about their psychological aspects. In this article we would like to deal with "pain as one of psychosomatic diseases", in which psychological factors play a particular role. There are several characteristics of the pain with psychological factors, namely ; 1) The effect of analgesics is not in proportion to its prescription. 2) Mental dependency on the medicine is a common problem of pain. 3) The location and range of pain do not correlate with the location and intensity of physical disorders. 4) We can observe behavioral and mental abnormality at the first medical examination. 5) The expression of pain is often either exaggerated or lack of emotion. 6) In many cases of external wound pain, problems of compensation are unsettled. 7) In spite of complaint of pain, instinctive desires such as appetite, sexual desire or sleep tend to be gratified. 8) The patient often changes doctors one after another. 9) They are impatient to call the ambulance. The pain as a psychosomatic disease is largely classified into two groups, A and B. A is the pain in which psychosocial stresses play a leading role, and B is the pain which is originated by an actual organic disorder and aggravated by psychosocial stresses. In this article we would like to mention the psychosomatic therapy for the B type. The therapy consists of three stages : l) Interview by which life style and psychosomatic state of the patient are investigated. 2) Pharmacotherapy against physical diseases. 3) Psychotherapy which has four fundamental techniques including assertion, relaxation, cognition and behavior modification. We also present two cases of chronic pain with malignant tumor. Lastly, we discuss five problems with regard to psychosomatic therapy of pain. They are l) discrimination between flight into disease and malingery, 2) prevention of analgesic dependency in case of psychologically oriented pain, 3) agonizing pain and analgesics, 4) recognition of the limitation of psychotherapy, and 5) development of an objective method to measure pain.

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We observed changes. in contents of noradrenaline (NA) and its principal metabolite, 3-methoxy-4-hydroxyphenylethyleneglycol sulfate (MHPG-S0.) in rat brain regions during 180 min. of stress combined immobilization with electric tail shock, and studied relationship between changes in these substances and gastric mucosae. The hypothalamus and amygdala showed decreases of NA contents already within 15 min. prior to the occurrence of gastric mucosal lesions which appeared after 30 min. This finding suggests that the rapid response of noradrenergic neurons in these regions plays a significant role in producing gastric mucosal lesion. Complete abolishment of glucocorticoid secretion by bilateral adrenalectomy potentiated the stress-induced increases of MHPG-S0. Ievels in the hypothalamus, amygdala and hippocampus, and the accelerated metabolisms of NA in the hypothalamus and hippocampus of adrenalectomized animals exposed to the stress were reversed by supplementary administration of corticosterone. It is suggested that glucocorticoid secreted via pituitary-adrenocortical system plays an inhibitory role in the responses of brain noradrenergic neurons to the acute stress.

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