Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome

BioPsychoSocial Medicine

Bernd Bergander¹  Laurence Erdur¹  Bettina Kallenbach-Dermutz¹  Hans-Christian Deter¹ 

[1] Department of Psychosomatics and Psychotherapy, Charité Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany

关键词: Attachment style;    Psychosomatic in-patient treatment;    Age;    Chronic somatoform pain;   

Others  :  1082362
DOI  :  10.1186/1751-0759-7-4

 received in 2012-10-02, accepted in 2013-02-01,  发布年份 2013

【 摘 要 】

Introduction

Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.

Methods

As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.

Results

Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R²=.108; model: p< 0.01).

Discussion and conclusion

Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.

【 授权许可】

   
2013 Bergander et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Egle U, Hoffmann S, Lehmann N: Handbuch Chronischer Schmerz. Stuttgart, Schattauer, 2. Aufl; 2007.
• [2]Nickel R, Hardt J, Kappis B, Schwab R, Egle UT: Determinants of quality of life in patients with somatoform disorders with pain as main symptom - the case for differentiating subgroups. Z Psychosom Med Psychother 2010, 56(1):3-22.
• [3]Bergander B: Die Arzt-Patient-Beziehung bei Patienten mit chronischen Schmerzen. In Die Arzt-Patient-Beziehung in der modernen Medizin. Edited by Deter HC. Ruprecht: Göttingen, Vandenhoeck; 2011.
• [4]Hechler T, Blankenburg M, Dobe M, Kosfelder J, Hübner B, Zernikow B: Effectiveness of a multimodal inpatient treatment for pediatric chronic pain: a comparison between children and adolescents. Eur J Pain 2010, 14(1):97.e1-9. Epub 2009 Apr 9
• [5]Pinter G, Likar R, Anditsch M, Bach M, Böhmer F, Friedrich M, Frühwald T, Gosch M, Gugerell M, Lampl C, Marksteiner J, Pietschmann P, Pils K, Schirmer M: Problems of pain measurement and pain therapy in the elderly. Wien Med Wochenschr 2010, 160(9–10):235-246.
• [6]Wulsin LR, Söllner W, Pincus HA: Models of integrated care. Med Clin North Am 2006, 90(4):647-677.
• [7]Herrmann-Lingen Herrmann C, Buss U, Snaith RP: HADS-D: Hospital Anxiety and Depression Scale, Deutsche Version. Bern: Huber; 1995.
• [8]Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale–preliminary report. Psychopharmacol Bull 1973, 9(1):13-28.
• [9]Hardt J, Gerbershagen HU, Franke P: The symptom check-list, SCL-90-R: its use and characteristics in chronic pain patients. Eur J Pain 2000, 4:137-148.
• [10]Fahrenberg J, Hampel R, Selg H: Das Freiburger Persönlichkeitsinventar FPI-Handanweisung Göttingen, Hogrefe. Psychologie: Verl. f; 1984.
• [11]Nickel R, Egle U: Therapie somatoformer Schmerzstörungen -Manual zur psychodynamisch interaktionellen Gruppentherapie. Stuttgart: Schattauer; 2006.
• [12]Raftery MN, Sarma K, Murphy AW, De la Harpe D, Normand C, McGuire BE: Chronic pain in the Republic of Ireland–community prevalence, psychosocial profile and predictors of pain-related disability: results from the Prevalence, Impact and Cost of Chronic Pain (PRIME) study, Part 1. Pain 2011, 152(5):1096-1103.
• [13]van Middendorp H, Lumley MA, Moerbeek M, Jacobs JW, Bijlsma JW, Geenen R: Effects of anger and anger regulation styles on pain in daily life of women with fibromyalgia: a diary study. Eur J Pain 2010, 14(2):176-182.
• [14]Boonstra AM, Reneman MF, Stewart RE, Schiphorst Preuper HR: Do male and female patients with chronic musculoskeletal pain differ in their pre-treatment expectations of rehabilitation outcome? J Rehabil Med 2011, 43(1):65-69.
• [15]Scascighini L, Litschi M, Walti M, Sprott H: Effect of an interdisciplinary outpatient pain management program (IOPP) for chronic pain patients with and without migration background: a prospective, observational clinical study. Pain Med 2011, 12(5):706-716.
• [16]Wang H, Ahrens C, Rief W, Schiltenwolf M: Influence of comorbidity with depression on interdisciplinary therapy: outcomes in patients with chronic low back pain. Arthritis Res Ther 2010, 12(5):R185. BioMed Central Full Text
• [17]Kiesewetter S, Köpsel A, Mai K, Stroux A, Bobbert T, Spranger J, Köpp W, Deter H-C, Kallenbach-Dermutz B: Attachment style contributes to the outcome of a multimodal lifestyle intervention. BioPsychoSoc. Medicine 2012, 6:2. BioMed Central Full Text
• [18]Bowlby J: Attachment. Vol. 1 of “Attachment and loss”. London: Hogarth Press; 1969.
• [19]Hardy GE, Aldridge J, Davidson C, Rowe C, Shapiro DA: Therapist responsiveness to client attachment styles. Psychother Res 1999, 9:36-53.
• [20]Brisch KH: Bindungsstörungen. Von der Bindungstheorie zur Therapie. Stuttgart: Klett-Cotta; 2000.