[Psychosomatic aspects of chronic pain]

This paper gives a report on the current views of psychosomatic theories on chronic pain. Based on Melzack's and Wall's "gate-control theory", Freud's ideas on hysteric neurosis, and Engel's "pain-prone patient" the unidirectional nociceptive model of pain is replaced by a cybernetic system of biopsycho-social etiology. The psychodynamic theories of pain-proneness, the narcissistic mechanism in the etiology of pain, the mechanism of conversion, states of psychovegetative tension and processes of learning are presented. In addition the impact of gain from illness, life-events, coping, the doctors behavior and the comorbidity of affective disorders on pain syndromes becoming chronic is pointed out. As an example the multifactorial etiology of chronic low back pain is demonstrated.