Chronic back pain: view from a psychiatrist's office.

Twenty-six adult outpatients suffering from chronic back pain were observed in a clinical study. Treatment was multifaceted. A psychiatrist with a subspecialty in pain management served as the coordinator of all treatments used. Treatment included biofeedback, physical therapy, behavioral-management program and pain measurement scales, psychotherapy with pain counseling, and medication. Patients were seen weekly for 4 months and observed for 1 year thereafter. Results of the study bore out the necessity of a coordinated multifaceted approach to treatment of chronic pain. Strong emotional overlay was seen in all patients. Stress, depression, and secondary gain are symptoms that were addressed along with the physical symptomatology. Patients improved significantly. The psychiatric component serving as the anchor for treatment was viewed as a key to success. The emotional component present in chronic pain must not be overlooked, because it plays a vital role in successful treatment.