Psychiatric approach to pain
" Liaison psychiatry of pain" (3 hours) – MUDr. Pavel Mohr, MUDr. Jiří Horáček,
(MUDr. Ján Praško, CSc.):)
Psychiatric aspects of pain:
Functional significance of pain: protection, warning, information
Symbolic meaning of pain experience, relationship between culture, emotions and pain (pain inrites of passage,
sacrifices, sex).
Dependence on context in pain experience: emotional value of the pain provoking situation, ethnic and social
differences in experiencing pain.
In practice - a.psychogenic pain - somatoform pain disorder ( ICD 10 category-F45.4)
Psychalgia without detectable or meaningful morphological and /or physiological causes often related to an
emotional conflict.
Mechanisms of dissociation and conversion.
Prevalence, clinical presentation, treatment.
 pain as a sign of acute stress response or disorder of adaptation-expression of an intense distress by means of
conversion or displacement of the original psychological condition.
 pain as an equivalent of a depressive disorder: masked depression. Differential diagnosis from primarily
physical pain symptoms.
 modulation of physically caused pain by anxiety and sadness.
Psychoanalytical models of pain
The influence of developmental psychosocial factors in forming the vulnerability to psychogenic pain.
Pain and pain treatment in the cognitive behavioural therapy
Psychotherapeutic treatment of pain
 relaxation techniques and attention displacement
 suggestion and hypnosis in the treatment of pain
 stress managing techniques
 cognitive behavioural techniques in managing somatoform symptomatology
Presentation of clinical vignettes and training.
Psychopharmacology of pain
Neurotransmitter and hormonal influences on pain perception
Treatment of "masked depression" and somatoform disorder.
Combined analgesic and psychotropic drug treatment
The efficacy of neuroleptic and antidepressant medication in the control of mild pain and additional medication
to analgesics in cases of severe pain.
Problems concerning medication with benzodiazepines (anti-conflict effects turned to symptoms of behavioural
desinhibition)
Case story clinical presentation
Vignette of a patient with persistent psychogenic pain-persistent somatoform disorder.
There are available case stories of two different patients . Both had repeated teeth extractions because of
psychogenic toothache. In one patient the pain was related to an emotional conflict, in the other patient it was a
displacement of depressive symptoms to somatoform ones, within a meaningful context of difficult life
circumstances.
More clinical vignettes will be presented and current patients invited to take part at this seminar, if available.