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The efficacy of inpatient psychosomatic psychotherapy was proved by a naturalistic prospective study with 50 psychogenic pain patients over an average time period of 12 weeks. At the end of inpatient psychotherapy about 60% of all patients achieved pain mitigation. According to the aim of our therapeutic concept to specially improve the perception and verbalization of their own conflicts or affects about 86% of all patients judged to have an enhanced competence in problem solving. The hypothesis that depression may often occur as a consequence of several years lasting chronic pain, could not be confirmed in our study. In contrast no remarkable correlation was found between symptom duration and depressive or anxious mood respectively. Concerning prognosis it seems to be significant that an increased tendency for rationalization or intellectualization diminished clinical outcome success as well as it occurred with enhanced acute pain sensation.
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PMID:[Inpatient psychotherapy with chronic psychogenic pain patients]. 797 47

In the last decade the boom in behavioural therapy studies of pain has relegated psychoanalytical publications on this topic quantitatively to the background. The present paper reviews the historical development and current state of the psychoanalytical understanding of pain. The results of those studies are summarized, which provide empirical support for the components of psychoanalytic pain theory. From these results a pathogenetic model for the psychogenic pain syndrome is developed.
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PMID:[Psychoanalytic concepts of pain. Historical development, current status and empirical evidence]. 832 38

In Germany patients with chronic pain are often undertreated. It is necessary to establish more specialized institutions for pain therapy. As pain therapy is time consuming and labor intensive the costs must be justified by quality and efficiency. METHODS. We analyzed the new patients who came to our pain clinic in 1990 and compared the previous nonspecialist pain-related treatment with our pain therapy. For each patient we recorded the duration of pain therapy in the past, the number of physicians involved in the treatment, the number and duration of hospital stays and the number of operations carried out to relieve pain. For our pain therapy we recorded the number of treatments on an outpatient basis, the number of patients who were hospitalized and the number of hospital days. The outcome of our pain therapy was determined on a visual analogue scale (VAS). Pain relief of more than 50% was defined as adequate pain therapy. RESULTS. In 1990 we treated 379 new patients in our pain clinic. The largest group (140, 37%) had pain of the muscle or skeletal system. A further 75 patients (18%) had neuropathic pain, 66 (17%) suffered from cancer pain, several types of headache were found in 57 patients (15%), 19 patients (5%) had phantom limb pain, 11 (3%) suffered from reflex sympathetic dystrophy, and we diagnosed psychogenic pain in 11 patients (3%). On average the patients had been treated for their pain over a period of 10 years by eight different physicians. Patients suffering from migraine had the longest duration of preliminary therapy (19.2 years), while patients with cancer pain were pretreated for 2, 3 years in the period before. 80% (n = 302) of all patients were hospitalized at least once. A total of 20,959 hospital treatment days was registered. At least one operation was performed in 34% of the patients (n = 130) to relieve the pain. For all patients the pain relief afforded by the preliminary therapy was insufficient. In our pain therapy the patients had on average 6.5 outpatient appointments. We hospitalized 45 patients (12%), for a mean of 11 days. During the observation period 74% of the patients (n = 280) obtained pain relief of more than 50% in comparison with the start of treatment. CONCLUSION. The findings of our retrospective study demonstrate that specialized pain therapy is evidently effective. If such therapy is instituted early enough, chronic pain can be prevented. Shorter duration of disease, fewer stays in hospitals and less absence from work could reduce the economic costs of chronic pain. It is necessary to make specialised pain therapy a regular component of clinical practice; this means redoubling our efforts concerning education and experimental and clinical studies. The efficiency of pain therapy must be documented in order to improve the care of patients with chronic pain.
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PMID:[Analysis of the therapy of chronic pain. A comparison of previous therapy and specialized pain therapy]. 848 Sep 4

The evaluation and proper clinical and legal management of pain clients defy simple remedies. Historically, human pain has challenged the most sophisticated of philosophical, theological, and biomedical explanations. Following an historical overview of pain concepts and treatment, this paper discusses the prevalence in and influence of pain on the modern world. One perspective for viewing multifaceted pain issues is a model developed by John Loeser. This four-level model addresses not only tissue damage (Nociception), but also the patient's perception of such damage (Pain), the negative emotional reactions to such perceptions (Suffering), as well as the pain activity stemming from such damage (Pain Behavior)--all issues critical in medical management as well as in personal injury litigation. Several methods for classifying pain are discussed, including acute vs chronic pain, benign vs cancer pain, "real" vs psychogenic pain, and a multiaxial coding schema for pain which encompasses a number of professional disciplines. Clinical pain assessment is then reframed and translated into a legal format more relevant to forensic discovery and case development.
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PMID:The evaluation and understanding of pain: clinical and legal/forensic perspectives. 848 44

Interviews with 18 male patients with predominantly psychogenic pain (DSM-III and DSM-III-R) and with 18 male patients with pain of mainly physical origin, consecutively admitted to a medical department, were rated by blinded and independent raters with respect to "symptom description," "manner of speech," "personality characteristics," "interviewer reactions," "interpersonal relationships," and "relationships at work." Patients with predominantly organic pain significantly more often described a clear localization of the pain symptom, used more sensory words for the description of pain quality; more often described discrete changes of pain intensity and periodicity; more often showed pain-intensifying factors dependent on movement and pain-decreasing factors; more often believed pain to be a symptom versus as a disease itself, and tended to have fewer difficulties in their interpersonal relationships than those with predominantly psychogenic pain (p < 0.05 for all factors, two-tailed Fisher's Exact test).
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PMID:How not to miss a somatic needle in the haystack of chronic pain. 919 25

Psychogenic pain has been described in many parts of the body such as limbs, digestive system, respiratory organs, and obstetrics. Computer searches have not found a single published case of psychogenic pain of dental origin. Two such cases are described within this paper, which describes pain severe enough to interfere with normal daily activity. The first describes a situation which resulted in 5 operations being performed before an adequate diagnosis was made and treatment started with hypnosis. The second was an inability to work, sleep, and lead a normal existence because of pain which had no organic origin. Hypnosis treatment allowed the patient to have a proper diagnosis before any operative treatment was given and resume normal activity.
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PMID:The use of hypnosis in the treatment of psychogenic oral pain. 938 20

In this article, the contribution of the psychotherapy schools to psychological pain therapy shall be explained. In the first part, relaxation methods, imaginative techniques hypnotherapy, and psychoanalysis as well as their importance for psychological pain therapy are presented. Research findings for autogenic training, progressive muscle relaxation and meditative methods are shown as example for relaxation methods. Imagery is shortly explained and associated to hypnotherapeutic methods. In hypnotherapy, research results, the pattern of a session and hypnotherapeutic strategies for pain reduction are demonstrated. In the explanation of psychoanalysis, the aims and explanation principles of analytic methods for the psychogenic pain development are shown.
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PMID:[Psychological concept of pain therapy. 1. Relaxation therapy, imagery methods, hypnotherapy and psychoanalysis]. 948 25

Orofacial pain, especially if the problem is chronic, presents a diagnostic and management challenge to all health practitioners. This paper suggests how clinicians might simplify the diagnosis of orofacial pain. First, the pain is classified into one of the three basic pain categories: somatic, neuropathic, or psychogenic pain. Somatic pain results from noxious stimulation of normal neural structures. Neuropathic pain is caused by a structural abnormality in the nervous system. Psychogenic pain arises from psychic causes; there is no apparent physiologic or organic basis for the pain. The next step is to determine the tissue system from which the pain arises: intracranial, extracranial, musculoskeletal, neurovascular, neurogenous, or psychological. Finally, some of the more common orofacial pain syndromes within each category are discussed.
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PMID:Differential diagnosis of orofacial pain. 984 62

Nonorganic chronic headache is a common, challenging presentation in clinical practice. The aim of this study was to investigate the frequency of associated psychiatric psychopathology, personality disorders, or traits. In addition, the study attempted to investigate possible relationships of nonorganic chronic headache with alexithymia, locus of control, and pain perception. Psychiatric pathology, personality traits, and pain profiles were examined in 100 randomized patients with chronic headache lacking an obvious organic basis, and they were compared with 100 subjects, 50 with headache of a known organic cause and 50 seemingly healthy persons, by using structured clinical interviews. Somatoform pain disorder was diagnosed in 43% of the nonorganic and 20% of the organic headache group. Nine percent of the former group had major depression, 16% had dysthymia, and 8% had both. In the organic group, 56% had no psychiatric disorder and 20% had somatoform pain disorder. Seventy-seven percent of the patients in the nonorganic pain group had personality disorders, mostly of the mixed and multiple types, compared with 24% of the organic headache patients. The study sample was more alexithymic than the other groups (in 65% of subjects) and had a culturally influenced locus of control and a pain profile characterized by dramatization, vagueness, lower pain threshold, and lower pain tolerance. The nonorganic chronic headache patients showed a high prevalence of somatoform, depressive, and other forms of psychiatric disorders. The high frequency of personality disorders, mostly the mixed and multiple types, the high alexithymic pattern, and low pain threshold and tolerance in the study group should be taken into consideration in the evaluation and management of nonorganic headache patients.
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PMID:A psychiatric study of nonorganic chronic headache patients. 1034 36

Nervous system anatomy knowledge acquired by arabo-islamic physicians enabled them to know its physiology represented by its excitability and its conductibility, and to understand pain physiology. Ibn Sina in his book entitle "The Canon of Medicine" precise anesthetic drugs and their side effects. Among these anesthetic means there were opium and ice. Ibn Sina distinguished organic pain and psychogenic pain. He used sedative and antalgic and soporific drugs in treatment of some psychologic diseases as melancholia. Moslem physicians were the first to use cold water to treat superficial burns. Anesthesia which lead to heavy sleep to used achieve surgical operations by oral, nasal(inhalation) and rectal route as it was described by Ibn Sina who indicated dosage to achieve three or four hour anesthesia which was necessary in an amputation surgery.
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PMID:[Anesthesia and resuscitation in Arabo-Islamic medicine: analytic study through Ibn Sina]. 1089 53


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