The psychiatrist and the chronic pain patient: 172 anecdotes

The clinical experience of a psychiatrist working in a pain clinic is described. One hundred and seventy two patients were assessed over a 4-year period. The modal age was 45–54 years with a male : female ratio of 7 : 10. The modal duration of pain was 1–5 years, the back being the commonest site. Depression was diagnosed in 30% of cases. Personality disorder, traumatic neurosis, anxiety, hysteria and drug dependence were the next most common diagnoses. Treatment was instituted in half of the patients seen and half of the treated patients improved or recovered. Drug withdrawal, EMG feedback and brief psychotherapy were associated with more improvement than pharmacotherapy or treatment at a psychiatric unit. The response to antidepressant medication was particularly disappointing and possible reasons for this are discussed.