EPA-0320 – The language of pain: how to understand, diagnose and manage chronic pain in the consultation-liaison psychiatry setting

Abstract

Pain is one of the most common complaints reported by patients, universal, disabling and often unspecific as to diagnosis, etiology and physiopathology. It is a complex experience, truly bio-psycho-social in its essence and therefore demanding multidisciplinary assessment and management. The database of the Modena Consultation Liaison Psychiatry (CLP) Service, operating in a 700-bed University General Hospital and providing an average of 1200 first psychiatric assessments annually, was searched quali-quantitatively to provide relevant examples illustrating the process of diagnosis and management of chronic pain: specifically, collaborations with the headache outpatient clinic, rheumatology and onco-ematology were analyzed and compared. In the assessment and management of pain in a CLP context, the following aspects are particularly relevant: 1) need to include systematic, standardized assessment of pain (by means of simple instruments like VAS); 2) psycho-pharmaceutical issues, i.e. related to abuse and addiction to pain-killers or anesthetic actions of psychiatric medications; 3) contextualization of pain within patients’ life- and health-history, i.e. the meaning of pain in the migrant patient; 4) the role of pain in the agitated patient with delirium/dementia. CLP and psychosomatic medicine play a crucial role in the management of patients with chronic pain, on many different levels, i.e. psychotherapeutic understanding of pain; research on neurobiology; integration and coordination of multidisciplinary care.