J Korean Med Assoc.  2006 Sep;49(9):825-834. 10.5124/jkma.2006.49.9.825.

Psychiatric Treatment of Chronic Pain

• Han JH

• KMID: 2137823
• DOI: http://doi.org/10.5124/jkma.2006.49.9.825

Abstract

Although pain is not only a physical but also an emotional and cognitive distress, psychiatric management of pain has commonly been overlooked. In this article the author will review the psychiatric assessment and treatment of patients with chronic pain. Pain is not a simple sensory process but a complex perception involving higher levels of the central nervous system, emotional states, and highorder mental processes. Thus the psychosocial aspect should be underscored in patients with chronic pain, and a multidisciplinary approach is necessary in the treatment of chronic pain. Tricyclic antidepressants are most widely used and have proven effective in patients with chronic pain. Anticonvulsants/mood stabilizers, anxiolytics, antipsychotics, and opioid analgesics are beneficial in some cases. Non-Pharmacological and psychological therapy of chronic pain includes cognitive-behavioral therapy, relaxation techniques, biofeedback, hypnosis, psychotherapy, and family therapy. New psychotropic agents and various psychological therapies need to be developed and be proven to be effective and tolerable in patients with chronic pain through well-controlled and long-term follow-up studies. Psychiatric treatments, both pharmacological and non-pharmacological, are helpful in patents with chronic pain.

Keyword

Chronic pain; Psychiatric treatment; Psychopharmacological treatment; Psychologically based therapy

MeSH Terms

Analgesics, Opioid
Anti-Anxiety Agents
Antidepressive Agents, Tricyclic
Antipsychotic Agents
Biofeedback, Psychology
Central Nervous System
Chronic Pain*
Family Therapy
Humans
Hypnosis
Mental Processes
Psychotherapy
Relaxation Therapy
Analgesics, Opioid
Anti-Anxiety Agents
Antidepressive Agents, Tricyclic
Antipsychotic Agents

Figure

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  Figure 1 Neurophysiology of nociceptive pain

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  Figure 2 Endogenous pain suppression pathways

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  Figure 3 Systems model for chronic pain

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