[Practical problems in the treatment of pain].

Résumé

According to modern pain concepts, "pain" is the result of multifactorial influences. Planning of therapy therefore requires the diagnostic evaluation of a number of factors including delineation of an organic lesion, evaluation of the influence of pain on the individual's psychological development, situational anxiety, psychological coping style etc. The understanding and management of psychological factors is crucial in every pain syndrome as the idea the pain is either psychogenic or organic is outdated. For the treatment of mild pain salicylic acid is still unsurpassed. The rationale of its combination with a tranquillizer, and with codeine or benzomorphane for moderately severe pain, can be understood on the basis of modern pain concepts. Before strong narcotics are used a trial with combination of a phenothiazine with a tricyclic antidepressant drug is warranted. Methadone seems to have advantages over morphine for very distressing pain treated with narcotics. Biofeedback for pain due to muscle spasms, electrical stimulation of the dorsal column for intense chronic pain due to a well-delineated organic lesion, and operant conditioning applied by a well-trained team of physicians and staff are promising new treatments for pain. The place of acupuncture in future pain therapy cannot yet be judged. It must first be freed of cult-type opinions and evaluated further by studies meeting modern western standards of pain research.