Stumbling-blocks: initiating a psychosomatic pain clinic

Objective. Despite psychosocial factors playing an important role in the co urse of chronic pain disorder,there is a noticeable imbalance between deman d and availability of psychosomatic care for these patients. This led us to establish a psychosomatic pain clinic within the framework of our outpatie nt clinic at the Department of Psychosomatic Medicine and Psychotherapy at the Central Institute of Mental Health, Mannheim, Germany. A recent study a imed at the evaluation of sociodemographic variables, state of chronificati on, symptom load and psychiatric comorbidity. Additionally we wanted to det ermine whether existing conditions at our hospital can be considered suitab le for those patients. Methods. During the clinic's first year we assessed 40 consecutive patients based on a psychosomatic interview as well as a set of psychometric questi onnaires (BDI, STAI, SCL-90-R). To detect differences between pain patients and psychotherapy inpatients, we compared the two groups in terms of socio demographic variables and symptom load. Results. Most pain patients were in advanced states of chronification, showing extensive psychiatric comorbidi ty, particularly anxiety and depressive syndromes. Drug addiction was found more infrequently. Use of the before mentioned questionnaires prevented us from underestimating existing anxiety syndromes. Pain patients differed su bstantially from psychotherapy inpatients in terms of age, education,fa mi ly status a nd symptom load. Conclusions. Our examination routine effectively demonstrated the special n eeds of chronic pain patients. As there is significant demand for psychosom atic intervention in those patients, earlier referal appears highly desirab le. As pain patients differ also greatly from the remaining hospital popula tion,specialized therapeutic concepts must be developed.