[Psychological pain treatment in rheumatic patients.]

Psychodynamic concepts postulate a psychogenesis of physical pain proposing several assumptions about the conversion of mental suffering into physical pain. Behavioural concepts, on the other hand, emphasize psychological conditions as risk factors for chronicity and describe psychological reactions to chronic pain. Patients with painful diseases and inadequate coping strategies very often display symptoms of anger, anxiety, or depression. Recently, the use of group therapy aimed at enhancing patients' ability to cope with disease-related stressful events has become widely accepted in behavioural medicine with a focus on pain-management procedures. Strategies for the improvement of coping with pain are based on behavioural, psychophysiological, and cognitive principles. The behavioural view conceptualizes pain as a behavioural problem with regard to facial and bodily expressions of pain, decreased physical and mental activity, and the consumption of pain medication. Operant conditioning is used to discourage pain behaviour and reinforce well-behaviour. The physiological concept stresses the vicious cycle of pain, increased muscle tension, and emotional reactions. Relaxation procedures are introduced in order to reduce excessive muscular activity in targeted muscles. The cognitive approach emphasizes the effect of information-processing on pain experience. Cognitive distortions are identified, and self-control management is encouraged. Having taken all of these aspects into consideration, we developed a cognitive-behavioural treatment programme in a group setting format with components of relaxation, cognitive restructuring, and the promotion of well-being. Subjects included in the study were given diagnoses of low back pain, tension headache, rheumatoid arthritis, and ankylosing spondylitis. Treatment effects in different diagnostic groups were compared to each other, supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis. Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being.