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1/18. Treating chronic-pain patients in psychotherapy.

    This article provides an overview of the breadth of issues a therapist may face in treating a person with chronic pain. Questions such as the relative contributions of biological and psychosocial influences on the patient's reported condition must be addressed. In addition, the counselor often must help the patient deal with psychopathology that occurs in reaction to the pain, which is likely to be contributing to it. Other financial, medical, and legal circumstances also may impinge on the therapeutic framework to limit or influence the course of treatment. Two examples of treatment lessons are offered, and a case example illustrates the lengthy and multidimensional course some treatments can take.
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keywords = psychotherapy
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2/18. Chronic back pain successfully treated with supportive psychotherapy.

    BACKGROUND: The primary purpose of this article is to report 4 cases of lower back pain successfully treated with psychoeducation. methods: Case studies of 4 patients with chronic back pain. medline data search of articles relating to chronic back pain. The patients were treated on an outpatient basis for a period of up to one year. RESULT: A structured program of psychoeducation was effective in reducing pain and disability in all four cases. CONCLUSION: There is increasing evidence of the role of psychological factors In the etiology and treatment of chronic back pain. A program of psychoeducation may be effective in treating certain patients with lower back pain.
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keywords = psychotherapy
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3/18. Pushing through solid rock: words of wisdom for clinicians from four patients with life-threatening conditions.

    Four subjects living with profoundly debilitating and life-threatening illnesses reflect on how psychotherapy has contributed to their ability to cope and survive. With frankness and eloquence they address issues related to cancer, heart disease, fibromyalgia, and AIDS.
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ranking = 0.25
keywords = psychotherapy
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4/18. Building bridges between body and mind: The analysis of an adolescent with paralyzing chronic pain.

    This paper describes the evaluation, initial psychotherapy and subsequent psychoanalysis of an adolescent who presented with a severe psychosomatic process involving total body pain and profound fatigue. The author details the complex and multifaceted nature of the psychosomatic process as it unfolded in the treatment. The psychosomatic problem was not a single entity, but rather was comprised of diverse interwoven elements such as somatization, conversion on pre-oedipal and oedipal levels, conflicts over aggression, sexuality, identity, masochism, secondary gain, anaclitic depression, internalized self-other interactions with a depressed mother and transgenerational transmission of trauma. The author uses the case material to discuss technical approaches to problems that often arise in the analytic treatment of patients with complicated chronic pain and fatigue as the primary complaints. Such approaches include respecting the mind-body split as a primary defense, speaking the language of the body along with the language of the mind and developing the verbal sphere around the non-verbal symptoms. The author emphasizes that complicated chronic pain problems are common and can be helped by psychoanalysis as long as the unique and complex features are understood and reflected in the technical approach.
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ranking = 0.25
keywords = psychotherapy
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5/18. hypnosis and existential psychotherapy with end-stage terminally ill patients.

    Existential psychological theory was employed as a conceptual and theoretical foundation for the use of hypnotically facilitated therapy in the management of intractable pain, nausea, and vomiting in 3 end-stage, terminally ill cancer patients. The existential principles of death anxiety, existential isolation, and existential meaninglessness were addressed with a combination of classic and Ericksonian techniques. The intractable nature of the presenting physical symptoms was conceptualized as a possible manifestation of the impact of the terminal prognosis. Direct hypnotic suggestions for the management of pain, nausea and vomiting were avoided. It was hypothesized that, as the existential conflicts associated with the patients' terminal status resolved, the physiological symptoms would become responsive to medication. After 6 sessions grounded in the principles of Existential psychotherapy, the intractable status of the physical symptomatology remitted, and the patients responded to medical management. This paper addresses the usefulness of Existential psychotherapy in hypnotic interventions for mediating somatic and psychosomatic symptomatology.
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ranking = 1
keywords = psychotherapy
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6/18. Testing the psychogenic vomiting diagnosis. Four pediatric patients.

    We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.
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ranking = 0.25
keywords = psychotherapy
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7/18. The utility of electromyographic biofeedback in the treatment of conversion paralysis.

    Conversion paralysis has a poor prognosis when there is evidence of nonresponse to previous treatment, long duration, and secondary atrophy of the "paralyzed" muscles. The authors present four such cases in which conversion paralysis was treated successfully by means of electromyographic (EMG) biofeedback. Each of the four patients also suffered from a chronic pain condition. Results from statistical analyses indicated that the four patients demonstrated significant improvement in the functional capacity of the "paralyzed" muscles as measured by isometric maximum voluntary contraction and EMG activity. The improvements occurred without explicit psychotherapy and suggest that behavioral modification techniques alone may be helpful in such cases.
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ranking = 0.25
keywords = psychotherapy
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8/18. Successful treatment of a chronic and disabling dermatosis by psychotherapy. A case report and discussion.

    It behooves us all to help contain rising medical costs. Accurate diagnosis and institution of appropriate treatment contribute to cost containment. A patient is described who entered psychotherapy after 14 years of competent dermatologic care for incapacitating and painful skin lesions with arthralgias. Drug and alcohol abuse, deteriorating peer and family relationships, and poor job performance had supervened. The successful outcome of her treatment is discussed.
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ranking = 1.25
keywords = psychotherapy
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9/18. hypnosis in the treatment of chronic pain.

    chronic pain can be treated by combining hypnosis with brief psychotherapy. hypnosis alone, though useful for acute pain, is seldom effective in relieving chronic pain because it does not address the significant psychologic components in the patient's illness. Treatment using self-hypnosis in conjunction with brief psychotherapy, however, can enable the patient to recognize these components, to change from a passive to an active role in achieving relief, and to modify his attitude toward the pain. This procedure can both reduce suffering and lead the patient to deemphasize pain in his life.
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ranking = 0.5
keywords = psychotherapy
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10/18. Interpretive psychotherapy with chronic pain patients.

    patients for whom medical and surgical management has failed to relieve chronic pain were treated in a multimodal programme which included interpretive psychotherapy. Dynamic conflicts were identified in all cases and utilized in the psychotherapy and programme design. Examined in the light of ego functioning, pain that was previously considered intractible, yielded to psychological treatment. Further research is planned to identify the parts played by the different modalities and to study outcome.
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ranking = 1.5
keywords = psychotherapy
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