The dissatisfied patient with chronic pain

Patients with chronic pain may become dissatisfied because of their lack of improvement. Thirteen such patients, encountered in a pain-management program, registered formal complaints of their dissatisfaction. From their histories they were found to be the most chronic and treatment-refractory patients encountered, with problems of medication dependency, accident proneness, and dissatisfaction with previous treatment efforts. During hospitalization they opposed psychologic approaches, further manifested their dependency on medication, and some of them had circumscribed delusions. The pain-management program was difficult to apply to these patients; and further, they resisted other recommendations for treatment and even resisted discharge in some instances. Further psychiatric screening is necessary to avoid the complications presented by this type of patient.