The use of psychotropic drugs in a pain clinic

The paper is based on experiences gained at a hospital pain clinic. Patients attending such a pain clinic can be divided into three categories: (1) Those with chronic organic lesions in whom the mental state was little affected. (2) Those with organic lesions who had mental changes which influenced their experience of the pain. (3) Patients who had primary mental changes in whom the complaint of pain was a symptom of their mental state. The importance of full history taking, ab initio, is stressed. Much can be learned from patients' ideas of causation and these should be considered. Phychiatric diagnoses should be reached positively and not by a process of exclusion. Distinction must be made between depression and normal sadness and it is important to establish the relationship between the onset of depression and the painful symptoms. When psychopathology is evident a variety of treatments are available. There is, however, a 'hard core' of patients who display no depression and little anxiety. In such cases the manipulative value of pain should be considered.