A psychosomatic approach to the treatment of the difficult chronic pain patient

Abstract

For the opioid-dependent chronic pain patient, opioids are typically ineffective with chronic opioid intake actually enhancing pain sensitivity. Opioid treatment is very seductive, however, in that each dose helps momentarily, even when the long-term course involves deterioration. For the patient, it is difficult to resist the immediate relative increase in comfort. For the doctor, providing opioids seems to offer a fast, simple solution to what may be a very complex problem. In the long-term, however, chronic opioid treatment of pain is associated with substantial risks, including accident proneness, unnecessary invasive procedures and tests, adverse health consequences, impaired judgment and cognitive function [53], decline in occupational and social functioning, and strained family relationships. If the opioid-dependent patient does not seek outside sources of opioids, a biopsychosocial approach that eliminates the opioids can result in gratifying improvements in pain and function.