Physiological and Psychosocial Understanding of Intractable Pain(Workshop/How to Deal with "Unmanageable Pain" in Clinical Practice - Knowledge of Intractable Pain for Clinical Psychologist)

Murakami Masato

doi:10.15064/jjpm.54.5_398

There are a lot of patients referred to the department of psychosomatic medicine complaining severe pain with a prolonged and chronic clinical course. Because various psychosocial stress factors in addition to the physical back-ground participate in the onset of chronic pain, the diagnosis and treatment tend to be complicated and difficult. For desirable treatment, it is important not only for physicians but also for psychotherapist to understand pain patient from physiological and psychosocial points of view. As the chronic pain is often a pathologic reaction against the stress and the correlation between physical symptoms and psychological stress factors is observed, the chronic pain can be regarded as a representative form of psychosomatic disease. Psychological reactions such as anxiety, anger, depression, hypersensitivity, or irritation experienced in our life or daily living are often related to the onset of chronic pain and sometimes modulate the state of illness very dramatically. To know the mechanism of perception of pain or pain control system is essential. To expect more definite efficacy in the medical treatment or psychotherapy, it is important to understand the psychosocial condition of chronic pain through the proficient history taking or appropriate psychological examination. Because the ordinary general analgesics are not effective, a combination of antidepressants or anticonvulsants may be more effective for the pharmacological treatment of such a chronic pain. Application of opioid agents is becoming another choice gradually these days. For the resolving and treatment of their emotional stress and personality problems, various combinations of pharmacological and psychosomatic approach such as cognitive behavioral therapy, transactional analysis, brief psychotherapy and other specialized psychotherapies are expected to be contributory. We conclude that consideration from the viewpoint of psychosomatic medicine is indispensable to the evaluation of pathogenesis and treatment of intractable chronic pain.

Physiological and Psychosocial Understanding of Intractable Pain(Workshop/How to Deal with "Unmanageable Pain" in Clinical Practice - Knowledge of Intractable Pain for Clinical Psychologist)

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