Psychiatria pre prax 1/2008

SOME NEW PIECES OF KNOWLEDGE IN PAIN DIAGNOSIS AND TREATMENT

The authors present some new pieces of knowledge dealing with pain diagnosis and treatment. The gate theory and Loeser´s and Turk´s segmentation remain as the ground but there are emerging lot of new mechanisms and new substances participating in the pain modulation and experience. Unfortunatelly in practice mind-body dualism has been inherent in the medical model of treatment. The biopsychosocial model was designed to overcome its limitations and is a recommended alternate strategy for more successfully managing the multiple dimensions that are associated with chronic pain. The difference between “somatic” and “psychological” pain is waning. Recent studies demonstrate that some brain structures activated by pain are also engaged when an individual observes someone else in pain, and that these empathy-related responses are modulated as a function of the affective link between the empath and the individual in pain. Relationships between psychical and physical pain are bidirectional: the participation of P-substance in depression, stress, and PTSD was established. In psychiatric practice the problem of pain is encountered in somatoform disorders first and foremost. The authors inform about the recent state of preparation of DSM-V, especially its chapter dealing with somatoform disorders.

Keywords: pain, biopsychosocial model, empathy, somatoform disorders