[Work disability and the granting of pensions in psychogenic rheumatic diseases]

This paper is the result of a symposium that addressed the problem of disablement and social pension for patients with psychosomatic-rheumatological complaints. This especially concerns patients suffering from psychosomatic manifestation at the locomotor apparatus, who are increasingly disabled and necessitating a pension, without actual somatic findings justifying a vocational disablement. Primarily it is a clinical picture of a generalized tendomyopathy, often underestimated in its importance. Definitions, causes, and clinical pictures are presented. A critical phase decisive for the disablement, the personality of the would-be pensioner, considerations for the physician regarding diagnostic and therapeutic efforts, elements of time and environment, and conditions at the work-place are discussed. In some cases a pension will be unavoidable and justifiable, even if the somatic findings seem not to be sufficient. The psychogenic picture must be carefully determined differentiated from simulation; determining the cause of aggravation is essential.