In recent decades, an increasing number of new psychotic and psychosomatic disorders have affected patients and therapists. These include chronic depression, borderline personality disorder, eating disorders, various types of addictions, dissociative disorders, ADHD, chronic pain disorders, and other psychosomatic disorders. All share a common feature ; they are all reportedly associated with insecure attachment and can be called “attachment-related disorders.” Attachment is physiologically based on the oxytocin system, and its dysfunction causes persistent and serious problems. According to the common medical model, doctors diagnose disease based on symptoms and alleviate symptoms by curing the disease. However, this model often fails in attachment-related disorders. This is because (1) people treated as patients are not always true patients ; (2) symptoms are not always true problems and offer shelters ; and (3) as symptoms and diagnoses change depending on the situation and developmental stage, the long lists of categorical diagnoses only confuse treatment. However, when one sees what is happening from the viewpoint of attachment, a clear understanding is gained. The fundamental problem underlying variable symptoms is dysfunction of the oxytocin system owing to damaged attachment. Therefore, it may be appropriate not to treat symptoms but improve insecure attachment, such as by improving the relationship with parental figures. I named this hypothesis “attachment model” and the treatment approach based on this model “attachment approach.”

I have worked at the Kyoto Medical Training Center for Juvenile Delinquents for 20 years. Most inmates suffered insecure attachment, and difficulties doubled or tripled with psychotic and somatic diseases, amphetamine addiction, family problems, and crimes. However, the common medical approach was almost ineffective. Nevertheless, some patients overcame these difficulties and retrieved themselves by restoring their relationships with their parental figures.

The aim of the attachment approach is to support parents as a safe base for their children and heal the damaged relationships between them. Counseling, cognitive work, skill training, and medications are sometimes applied to parents. This approach often causes significant changes. It is desirable to continue support even after a good relationship has been restored.

Another attachment approach was developed for those who could not expect parental cooperation but wished to overcome insecure attachment by themselves. Programs composed of psychoeducation, cognitive and mentalization training, mindfulness, daily tasks, and homework were offered. Through step-by-step cognitive and practical exercises, the participants learned to observe things apart from their own viewpoints. Among the 93 patients who participated in more than ten sessions, 94% showed some improvement. However, there have been a few cases of deterioration. Although the evidence level is limited, considering the difficulty of these problems, this result provides hope.

Pain is a physical and emotional experience. Physical pain and social factors have a complex and mutual relationship. Basic research using rodent models has advanced the understanding of factors involved in pathological and non-pathological pain and contributed to the development of various drugs. However, to reveal the interactions among pain, mental activity, and the psychosocial environment, it is necessary to develop proper experimental paradigms.

We established a new experimental protocol combining a chronic pain model and social defeat stress model and investigated the effect of stress load on the chronic pain model. The recurrence of pain pathology was caused by social defeat stress. We also recorded an increase in the levels of inflammatory cytokines in the plasma by stress loading and showed that the administration of inflammatory substances caused pain recurrence. Additionally, spinal cord microglial reactivation was observed after stress loading and systemic inflammation.

Taken together, we suggest that microglial reactivation, correlated with the systemic inflammatory response after stress loading, is involved in the pathology of refractory pain.

Microglia, a type of brain cell, respond rapidly to minute environmental changes and function as the center of the immune response in the brain by phagocytosis and cytokine production. Their dysfunction and abnormal activation have been suggested to be involved in various pathological conditions. Chronic pain is a multifaceted disease unique to humans. Therefore, it is necessary to conduct experiments using human cells. However, these hurdles were incredibly high. We successfully developed a technique to generate induced microglia-like cells (iMG cells) from monocytes in the peripheral blood. iMG cells can be generated by adding two cytokines, GM-CSF and IL-34, to monocytes and culturing them for 2 weeks. Unlike iPS cells, iMG cells can be produced by chemical induction without genetic recombination, making them simple, safe, and easy to produce in clinical facilities. We have previously reported microglial abnormalities in diseases such as Nasu-Hakola disease and bipolar disorder using iMG cells. In this presentation, we report our results on the utility and potential of our iMG cells as a translational research tool and actual translational studies in fibromyalgia.

Modern-Type Depression (MTD) is an emerging type of depression in Japan. Some unique psychological traits related to MTD are known ; however, no study has attempted to determine their relation with chronic pain. We introduced a recently published cross-sectional study to determine possible associations between these psychological traits and chronic pain in patients at psychiatric clinics (Fujimoto et al., Front Psychiatry, 2021). A total of 221 first-time patients who visited the psychiatric clinic at a Japanese university medical center or an associated clinic were enrolled. The Hamilton Depression Rating Scale was used to assess the depressive symptoms. The 22-item Tarumi’s Modern-Type Depression Trait Scale and 20-item Toronto Alexithymia Scale were used to assess the psychological traits related to depression and chronic pain. The clinical diagnosis of each patient was confirmed using Structured Clinical Interview for DSM-IV Axis I Disorders, administered by experienced specialists. The medians obtained for the psychological traits were compared between patients with or without chronic pain. Among the 221 patients, 139 had chronic pain. Patients with chronic pain had more severe depressive symptoms, alexithymia, and high scores for the complaints of TACS-22. Complaint trait for MTD was shown to be related to chronic pain in psychiatric settings. Further studies will allow us to design multidimensional approach for patients suffering from depression.

Background : Methods of treatment for patients with complex regional pain syndrome (CRPS) have not been established, and therefore psychological support is an essential dimension for improving their quality of life. The purpose of this study was to reveal how pain catastrophizing influences online information-seeking behavior when they gain medical information.

Method : Semi-structured interviews of 4 patients with CRPS (age of range : 29-46, female : 3, non-binary : 1) were conducted to clarify the psychological process related to pain catastrophizing during information gathering.

Results : The results of analysis by SCAT (Steps for Cording and Theorization) and data organization of pain acceptance processes and pain catastrophization during online information-seeking showed that the data were classified into 3 categories of rumination and 1 category of magnification. Remarks related to helplessness were not identified. Given that the characteristic psychological processes during online information-seeking behavior were rumination and magnification, it is important to note that an interaction between the two can lead to a vicious cycle of addiction.

Conclusion : Reducing the pain catastrophic degree and having social support during online information-seeking will help patients be objective while consuming pain-related information online without pain catastrophizing. Thus, patients with CRPS might break the cycle of online information-seeking that can be both negative and addictive.