Psychodynamic Understanding and Treatment of the Chronic Intractable Benign Pain Syndrome-Treatment Outcome

Abstract

Medical teaching stresses the value of a diagnosis based on changes or alterations in normal anatomy or physiology that are reflected in signs and symptoms with which the patient presents. The unfblding of' the historical sequence of the patient's signs and symptoms is of primary iniportance in the formation of a diagnosis.When there is a problem of pain, of necessity there will be a search for appropriate pathoanatomic or pathophysiologic peripheral sources of the noxious input that has resulted in the person's suffering. This is in the nature of good medical practice and there should be no difficulty in reaching an agreement about this. A problem with pain, accompariied by a source of discernible input, is by definition a perception of the central nervous system generated by active peripheral abnormality. 'rhese types of medical problems are relatively easy to diagnose when the medical history and examination, and the appropriate laboratory and other widely available diagnostic aids, have been used.There are, however, many persons who have intractable and chronic problems with pain that are not related to any discernible ongoing pathoanatomic or pathophysiologic process, and a current source of noxious input cannot be identified. Often there has been a past medical history of noxious input from the same painful peripheral locales, but tissue reparations have long since been complete. It is at thisjuncture that the patient's personal history and the centrality and extent of focus on his or her pain complaint must be thoroughly explored. In this process the epiphenomena1 and psychosocial life events of the patient should play a large role in the physician's interpretation of the

An approach to chronic pain of non-malignant origin

“…The results of treatment of patients with chronic pain must attend mainly to long-term results before it can be determined if there were any beneficial effects of treatment (Crue, 1983). These are difficult to perform long-term follow-up studies, and we have reported on our work (Pinsky, 1983;Pinsky et aL, 1979).…”

“…Furthermore, we believe this type of mechanism can explain all chronic pain syndromes in categories 5 and 6 of the classification in Table 1. This type of chronic pain syndrome has been described by us in the past (Pinsky, 1978(Pinsky, , 1983) as a chronic intractable benign pain syndrome (CIBPS). Descriptors of this syndrome are presented in Table 3.…”

“…We have described the chronic intractable benign pain syndrome in earlier publications (Pinsky, 1975(Pinsky, , 1978(Pinsky, , 1983Pinsky and Crue, 1984) and include Table 3 here in order to provide clinical descriptors for this syndrome in this discussion.…”

“…When people develop these chronic intractable pain syndromes, we are confronted not only with pain behaviour (Fordyce, 1976) and abnormal illness behaviour (Mechanic, 1968;Pilowsky, 1969), but with a more generalized maladaptive syndrome that has multifaceted levels of disorder that are reflected in poor adaptation (Pinsky, 1983). In addition, our psychological clinical experience with over 600 patients with these types of chronic pain syndromes indicates that a large percentage have life histories that include early childhood abuse (sexual and physical), biological family alcoholism, and broken and multiple family existences.…”

“…In addition, our psychological clinical experience with over 600 patients with these types of chronic pain syndromes indicates that a large percentage have life histories that include early childhood abuse (sexual and physical), biological family alcoholism, and broken and multiple family existences. Serious questions about the relationships between depression as a disorder of mood and chronic pain syndromes remain unanswered (Pinsky, 1983;Sunde, 1983). Situational problems that are normally considered as contributing to psychological secondary gain are also commonly present.…”