[Family emotional climate of pain patients]. / Familienklima chronischer Schmerzpatienten.

Personal clinical experiences in an interdisciplinary pain clinic and their integration into family interaction theories led to a concept of an explorative study of chronic pain patients. Therefore 32 patients and their spouses were investigated with the "family-environment-scale" (by Moos and Moos 1981, adapted by Schneewind et al. 1985). Most of the couples showed agreement with regard to familial solidarity, combined with few expressions of anger and conflict and low achievement orientation. The typical profile of these factors led to one group with the "positive-emotional family climate", in contrast to one group with the "normative-authoritative family climate". In addition, a potentially new factor was described as a so-called "symbiotic family climate". The latter constellation was on the one hand quite similar compared to the "positive-emotional climate", but differed on the other hand because of the small amount of structural control. The interference of these family climate profiles with the process of chronification for pain patients is discussed.

[The clinical picture of the chronic pain patient-Analysis of a pain outpatient clinic using headache as an example.]. / Das klinische Bild des chronifizierten Schmerzpatienten : Analyse einer Schmerzambulanz am Beispiel des Kopfschmerzes.

INTRODUCTION: Patients with chronic headache are seen in an interdisciplinary pain clinic after many years of treatment. Compared with other pain syndromes, the standards for diagnosis and treatment are widely accepted according to the guidelines of the International Headache Society. Nevertheless, many patients continue to suffer. Analysis of their special clinical features may help to clarify what kind of conditions potentially cause chronicity. PATIENTS AND METHODS: A total of 193 patients were seen in 1992-1993 in our pain clinic. Epidemiological, medical and psychological data were analyzed retrospectively. Classification of headache syndromes and pain behavior was based on the criteria of the International Headache Society, taxonomy of the Multiaxial Pain Classification System for Somatic Dimensions (MASK-S) and "Stages of Chronicity". Important psychodynamic factors were taken from standardized psychological interviews. RESULTS: The patients had a mean age of 46 years; 67 % of them were female. Fifty-three percent of the patients suffered from chronic tension headache; a high percentage was suspected to be caused by analgesic intake. Because of their pain behavior, 68 % were classified as being in an advanced chronic stage with a poor prognosis. The most important findings of the psychological diagnosis was that 40 % of patients had a depressive style of conflict solving. CONCLUSIONS: The results are discussed with respect to their relevance in explaining development of chronic pain, as seen in selected headache patients in an interdisciplinary pain clinic.

[The combined pattern of physiologic and relation dynamic processes in long-term encopresis]. / Das gemeinsame Muster physiologischer und beziehungsdynamischer Prozesse bei einer langjährigen Enkopresis.

The treatment of a case of encopresis of six years duration in a boy now ten years of age demonstrates how physiological and dynamical processes in personal relationships combine in a common evolution. Through this the encopresis has become chronic and has lead to other instances of developmental retardation in the form of inadequate school performance. The fundamental concept behind the psychotherapeutical treatment stems from the recognition of an inner connection between the current symptoms, the chronic nature of the disease and the lack of success of previous disciplinary, medical and psychotherapeutical attempts at a solution.