Alexithymia has been shown to be related to many psychosomatic disorders including a number of chronic pain conditions. A lot of previous studies have found the correlations between alexithymia and several pain-related measures, such as pain intensity, prevalence, depression, anxiety, and illness behavior. However, their causality and underlying mechanism remain unclear. It is suggested that alexithymia is a disturbance in cognitive processing and emotional regulation that may cause and exacerbate somatic symptoms, social pain and illnesses through physiological, cognitive, behavioral, and social pathway. In this article, we review the findings from previous studies on relationship between alexithymia, emotional regulation and pain and then discuss management of alexithymic patients with chronic pain.

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Pain catastrophizing is a cognitive process that is characterized by fixed attention to the pain, helplessness and overestimation at threat of the pain. It is the component of the fear-avoidance model and associated with pain intensity, disability and prognosis, therefore can be conceived as the cognitive element that cannot be passed over in psychosomatic treatment for chronic pain syndrome. Pain catastrophizing scale (PCS), which is the scale of pain catastrophizing, is composed with the three subcategories of rumination, helplessness and magnification. Mindfulness which is a non-judgmental awareness of experience in the present moment is suggested to moderate between pain intensity and catastrophizing, therefore has been coming up for an available treatment method for chronic pain.

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It is difficult to treat and manage chronic pain patients with many complex factors including many psychosocial factors. Chronic pain is one of the important psychosomatic diseases (PSD). Then 'a guideline for the diagnosis and the treatment of chronic pain as PSD' was made in 2002. The purpose of this paper is to investigate diagnosis and estimate the psychosocial and cognitive-behavioral factors and these characteristic of chronic pain patients from the viewpoint of psychosomatic medicine (PSM). The aims of treating chronic pain with psychosomatic treatments are not to distinguish pain itself, but to live with pain, to have self control senses, to activate daily lives, and to improve adaptation to social lives. So it is important to treat and manage each chronic pain patient with manifold and gradual diagnosis and treatment, having a good relationship between doctor and patient.

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In this article, the effectiveness of cognitive behavioral therapy for chronic pain and the mediator and moderator of treatment effect were reviewed. Although the overall effectiveness of cognitive behavioral therapy for chronic pain was confirmed in several meta-analyses, the effect sizes of treatment were small and in some outcome improvements were not confirmed. Previous studies exploring mediator and moderator of treatment for chronic pain indicated the importance of cognitive factors as mediator and MPI sub-groups and expectancy as moderator. Suggestions for the clinical practice and future direction were discussed.

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The oxidative balance defense system is thought to be one of the homeostasis mechanisms of the living body. The distortion takes part in the appearance of lifestyle diseases. The patients with painful diseases, such as chronic lower-back pain, fibromyalgia, and rheumatic arthritis were measured on oxidative stress (d-ROM test), and anti-oxidant potential (BAP test) and modified BAP/d-ROM ratio (modified ratio) by FRAS4 (Free Radical Analytical System 4). The oxidative stress and the modified ratio of the fibromyalgia were deteriorated compared with the healthy group, which was, however, not as bad as rheumatic arthritis. Reductive type coenzyme Q10, which was an antioxidant substance, was administered for three months for the correction of the oxidative balance defense system. As a result, pain VAS improvement and the improvement of the oxidative balance defense system were observed. It was thought the evaluation of the oxidative balance defense system was important in the diagnosis and treatment of fibromyalgia.

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Fibromyalgia (FM) is characterized by long-lasting widespread pain of muscular-skeletal system and is regarded as the representative disease of chronic pain. The onset and clinical course of FM involves many psychosocial factors, and their symptoms are often affected by weather, environment, social events, psychosocial stress and physical condition. The pain and variable symptoms of FM patients are sometimes highly susceptible to the negative or unfavorable emotion such as anger, grudge, anxiety, or catastrophic and depressive mood. Personality attributes may be involved in the formation of their emotion like strong tendency of obsession-compulsion, enthusiasm, perfection and nervousness. Their biased lifestyle such as over-adjustment and self-injunction based on so call "life-script" were also problems. Negative emotion and subsequent psychophysical exhaustion may arouse the muscle spasm, ischemic change, and hypersensitivity of general system including muscular-skeletal and visceral organs resulting in enhancement and prolongation of the pain. For the resolving and treatment of their emotional stress and personality problems, combined therapy of pharmacological and psychosomatic approach such as cognitive behavioral therapy, transactional analysis, brief psychotherapy and other specialized psychotherapies are expected to be contributable. We conclude that consideration from the viewpoint of psychosomatic medicine is important in the evaluation of pathogenesis and treatment of FM.

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Low back pain is the most commonly reported symptom in Japan, and in particular, chronic low back pain is often complicated by psychiatric problems. Fukushima Medical University offers liaison treatment of orthopedics and psychiatry for chronic low back pain. In order to improve the outcomes of low back pain treatment, it is necessary to conceptualize low back pain as a "biological, psychological, and social pain syndrome". Patients with persistent and refractory chronic low back pain are often revealed to be somatoform disorders. No drugs have been shown to be effective for the various types of somatoform disorders, which include chronic low back pain. In the treatment of chronic low back pain, it should be particularly noted that personality disorders are often treatment-resistant factors. Cooperation between orthopedics and psychiatry is important in the treatment of chronic low back pain.

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For the past few years, the author has seen cases where a psychological approach has been applied to children, and has noted that a significant amount of importance is placed on the continuation of the relationship between husband and wife over children's symptoms, for example, the husband (father) takes the child out to help his wife, and due to his worry over his partner's health, scolds the child rather than caring for its physical symptoms. Then, to place emphasis on providing psychological interview and educational guidance to parents, the author assumed that it is important to comprehend the level of intimacy between husband and wife, and attempted to develop an "intimacy scale of relationship between husband and wife". Subjects: 1. Study 1: A preliminary questionnaire, called the "Draft questionnaire for creating intimacy scale between husband and wife," was given to 100 parents of undergraduate students of T women's university and 100 parents of undergraduate students of M university. The collection rate was 30 percent for each university. "A total of 97 items from 56 parent-related items and 41 child-related items" was created according to the results of study 1. 2. Study 2: Another questionnaire was given to 1000 parents of undergraduate students of T women's university and M university, 100 parents of private-school kindergarten children, 50 parents of outpatient children of Y clinic, 100 parents working at hospitals, 30 parents of public junior high school students, 30 parents of private high school students, 30 parents of outpatient children of H clinic, and 30 parents of pediatric outpatients of a university hospital. The questionnaire was handed out to 1370 parents and the collection rate was 77.4 percent. Among the 1037 returned questionnaires, 650 were valid. More than half were returned blank and discarded. The breakdown of people who provided valid responses was male : 285 male, female : 365. Method: A Promax rotation was performed on the valid 650 responses for "a total of 97 items from 56 parent-relationship items and 41 child-related items". Factors with an eigenvalue of 1 or more, and factor loadings of 0.35 or more were adopted. Four factors were extracted from parent-related items (hereinafter referred to as "P scale") and child-related items (hereinafter referred to as "C scale"), and 31 items from P scale and 25 items from C sale were selected. Results: Factor I of P scale is defined as "dependant couple", factor II "stable couple", factor III "discontent couple", and factor IV "respect couple". Factor I of C scale is defined as "child-oriented couple", the factor II "child-noninterference couple", factor III "child-denying couple", and factor IV "child-distrust couple". The reliability and validity of each factor have been confirmed. Conclusion: From the correlation with the "family function", it is inferred that conventional family functions have changed, and the study suggests that the change can lead to confusion in children.

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Objectives: Recently, some psychosomatic approaches become required in the patients for dental treatments, meaning that psychosomatic factors should be evaluated at the first admission. This study aimed to evaluate the contributions of psychosomatic factors to chronic orofacial pain development and clarify the relationship between the psychological states and some questionnaire scores. Subjects: Among 1,878 outpatients, who visited the dental anesthesia clinic at Niigata University Medical and Dental Hospital, 318 subjects who agreed with the aim of this study were recruited. They consist of 195 patients with some chronic orofacial pain and 123 patients without either psychological problem or chronic orofacial pain who were scheduled for intravenous anesthesia during oral surgeries. Methods: Subjects were asked to complete psychological questionnaires before consultation of the first admission to the clinic. These questionnaires consisted of the Hospital Anxiety and Depression Scale (HADs), the State and Trait Anxiety Inventory (STAI), the Self Rating Questionnaire for Depression (SRQ-D) and the Somatosensory Amplification Scale (SSAS). Physical disorders were examined about the pain duration, painful area, visual analogue scale, cause, physical diagnosis of orofacial pain, and psychosomatic diagnosis. According to the scores of these questionnaires, patients were categorized according to the following groups; the Pm group who complained some psychosomatic claims but any physical causes for pain could not be detectable, the Pp group who had some psychosomatic symptoms and physical causes and the C group who did not have any pain or psychological problems. Results: Anxiety and depression scores of the HADs were significantly higher in the Pm and the Pp groups compared with the C group (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017). The Pm group exhibit significantly higher scores than the C group in state and trait scores of the STAI (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017) but the Pp group did not in either scores (p>0.017). There was a significant difference in the score of SRQ-D among these groups and the Pm group showed the highest score (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017). SSAS showed a significant higher score in the Pm group compared with the other groups (Kruscal-wallis one-way ANOVA, and Mann-Whitney U-test with Bonferroni correction, p<0.017) but there was no significant difference between Pp and C groups (p>0.017). Conclusion: The patients with orofacial pain tend to exhibit high anxiety and depression state irrespective of whether or not physical causes exists and it is suggested that psychological states have some contributions to the development of pain symptom.

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