[The benign chronic pain syndrome. Diagnostic subgroups, screening parameters, biographical disposition]

The concept that all pain must have an organic cause if not the pain is not real, is still very common in medical practice. For chronic pain this leads to big costs by repeated technical examinations and often even to iatrogenic injury to the patient as a result of diagnostic or therapeutic interventions. Psychogenic pain patients are particularly afflicted by this process of chronification. The results of a study investigating 151 chronic patients show, that psychogenic pain patients (PP, n = 75) are significantly different from those whose pain was caused by organic factors (OP, n = 35) regarding their development in childhood and adolescence (in the sense of a marked emotional deprivation). Including additional parameters raised by a structured interview (SBAS) and the trait-score of the STAI an identification of PS is possible with high sensitivity and specificity (about 95 percent). By the aid of the maturity of defence mechanisms three taxonomic subgroups in PP can be differentiated (type A, B, C). Between these types there are significant differences regarding illness behaviour (e.g. medication abuse, "doctor shopping") and responsiveness to a psychological pain interpretation. The results confirm the necessity of a differentiation of chronic pain patients as to the etiology and pathogenesis and furnish even the physician without psychosomatic education with diagnostic criteria relatively simple to raise. By these criteria a prevention of chronification in a lot of pain patients is possible. Derived from the results a pathogenic model for psychogenic pain is developed.