Mental health aspects and the doctor-patient relationship do matter in the management of refractory chronic pain

Abstract

Chronic non-cancer pain (CNCP) is among the clinical conditions that most challenge curative medicine due to its high therapeutic failure rates. In many cases, pain management teams are unable to identify a clear organic cause for the pain condition; in others, an etiological factor is found that can be attributed to the condition, but it is recognized, either promptly or after some years, that this organic substrate is insufficient to sustain the patient’s suffering for such a prolonged period; finally, there are cases in which the presumed organic cause of pain is corrected, yet the patient does not improve or does not improve as expected. The aim of this paper is to present a literature review on mental health aspects and the doctor-patient relationship involved in the management of patients with refractory CNCP. A systematic search and literature review methodology was employed, using the descriptors intractable pain, pain management, medical history, medication review, physician-patient relationship, and mental health evaluation in the Cochrane Central, PubMed, and LILACS databases, with no restrictions regarding study design, language, or publication date. Ten suggestions are presented as a result of the analysis of the included articles and the authors’ experience, some related to the semiological approach and others to the therapeutic follow-up of patients with CNCP. The suggestions presented may be useful in the management of refractory CNCP cases and should preferably be implemented before indicating invasive procedures.

Keywords

• intractable pain
• medical history taking
• physician-patient relations
• psychiatry
• clinical psychology