Psychological aspects of chronic pain

Except in emergencies, the physician's obligation is not to relieve pain, but to diagnose and treat pathology. Psychological factors complicate organic pain, and make the diagnosis of "psychogenic" pain virtually impossible on the basis of psychological tests alone. In acute (short-term) pain, anti-anxiety agents are useful, but in chronic pain antidepressants are usually more appropriate. Continuing anxiolytic drugs past the acute stage tends to potentiate depressions. In addition to antidepressants, modalities which help in the management of chronic pain are physical therapy, transcutaneous electrical neurostimulation, use of weak analgesics on a "clock" rather than an "as needed" basis, and behavior modification. Explicit agreement on the features of the doctor--patient relationship is almost always essential for successfully managing these difficult and demanding patients.