Program for managing chronic pain. I. Program description and characteristics of patients.

A program for the management of patients with treatment-resistant pain involves behavior modification, physical treatment, medication management, and counseling. The first 50 patients were characterized by pain of many years' duration, multiple operations, treatment failures, prolonged disability, compensation factors, and dependency on medication. In addition, they demonstrated loss of intellectual efficiency and were more psychologically deviant than the general medical population. Management problems were encountered in the following areas: patient acceptance, drug seeking, complicating psychopathology, complicating physical disorders, group dynamics, family reactions, and staff morale. Fifty-four percent of patients achieved moderate to marked improvement.