Psychological management of pain.
PURPOSE: In this article an overview is given on the attempts of understanding and treating chronic pain from the psychodynamic view and the perspective of behavioural medicine. ISSUE: Pain cannot be reliably measured. Assessment of pain depends on verbal description, nonverbal expressions, specific tests and our empathy. From this perspective pain is a matter of subjective experience and communication. Several phenomena (e.g. phantom limb pain, stress analgesia, the pain-relieving effects of relaxation, hypnosis, placebo, etc., pain in spite of a non-existing injury) obviously show that psychological factors like distraction, relaxation, fear, depression, former pain experiences as well as family and cultural influences modulate the way pain is experienced. Different parts of the CNS are involved in the modulation of pain-experience. Referring to cognitive and emotional processes, the importance of the the neocortex and and the limbic system are to be underlined. CONCLUSION: Chronic pain (as a category of ICD-10) presupposes a continuous, torturing pain, which sometimes even cannot be explained sufficiently by an organic damage. Psychosocial problems such as emotional conflicts, misleading thoughts, etc. are recognizable and can be brought into connection with the pain the patient experiences.