[Consultation or liaison psychotherapy service--what difference does it make for an outpatient pain clinic?]

Even if the effectiveness of psychotherapy emphasising a cognitive behavioral approach is clearly shown by randomised controlled trials, it is difficult to motivate chronic pain patients to use this type of treatment. We compared the effectiveness of consultation and liaison models of co-operation between an outpatient pain clinic and a psychosomatic department in creating motivation to psychotherapy.

In a retrospective design we collected data of all patients seen in the pain clinic during two periods of 6 months before ( N=165) and after ( N=277) changing from a consultation to a liaison model. Clinical data were documented by the MASK system (Hildebrandt u. Pfingsten 1993). Depression was screened using a depression scale (vgl. Zerssen 1973), somatic complaints by listing of complaints (vgl. Zerssen u. Koeller 1976) and two short screening questionnaires.

In the liaison model diagnostic sessions with the consulting psychotherapist were significantly more often recommended by physicians from anaesthesia departments (25.6% vs 13.9%; p<0.01) and accepted by patients (63.3 vs 30.4%; p<0.01). In both systems 80% of the patients accepted the suggested psychotherapy. After changing to the liaison type of co-operation, there was a significant decrease in the prescription of opioid and benzodiazepine drugs.

The liaison model of co-operation was significantly more effective to enhance physician's and patient's motivation for a psychosomatic approach to pain treatment. Psychotherapy is better accepted by patients suffering from chronic pain if it is offered in a multidisciplinary context and in the familiar surroundings of the pain clinic.