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Psychiatric Treatment of Chronic Pain

Article information

J Korean Med Assoc. 2006;49(9):825-834
Publication date (electronic) : 2006 September 30
doi : https://doi.org/10.5124/jkma.2006.49.9.825
Jin-Hee Han, MD
Department of Psychiatry, The Catholic University of Korea College of Medicine, Korea. saintnp@chol.com

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 high-order 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.

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

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Copyright © 2006 Korean Medical Association

Figure 1

Figure 1

Neurophysiology of nociceptive pain

Figure 2

Figure 2

Endogenous pain suppression pathways

Figure 3

Figure 3

Systems model for chronic pain