title: Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome.
abstract: BACKGROUND
  Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.
  
  
  METHODS
  As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.
  
  
  RESULTS
  Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients' degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01).
  
  
  CONCLUSIONS
  Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient's baseline level of anxiety influenced the outcome. These factors need to be studied in future research.
authors: Department of Psychosomatics and Psychotherapy, Charité Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, 12200, Germany. laurence.erdur@charite.de.
authors: Bernd
authors: B
authors: Bergander
authors: Laurence
authors: L
authors: Erdur
authors: Bettina
authors: B
authors: Kallenbach-Dermutz
authors: Hans-Christian
authors: HC
authors: Deter
references: Pain Med. 2011 May;12(5):706-16
references: 21463468
references: Eur J Pain. 2000;4(2):137-48
references: 10957695
references: Psychopharmacol Bull. 1973 Jan;9(1):13-28
references: 4682398
references: Z Psychosom Med Psychother. 2010;56(1):3-22
references: 20229488
references: Arthritis Res Ther. 2010;12(5):R185
references: 20937108
references: Wien Med Wochenschr. 2010 May;160(9-10):235-46
references: 20632152
references: Pain. 2011 May;152(5):1096-1103
references: 21450402
references: Eur J Pain. 2010 Feb;14(2):176-82
references: 19375966
references: J Rehabil Med. 2011 Jan;43(1):65-9
references: 21174053
references: Eur J Pain. 2010 Jan;14(1):97.e1-9
references: 19362031
references: Med Clin North Am. 2006 Jul;90(4):647-77
references: 16843767
references: Biopsychosoc Med. 2012 Feb 02;6(1):3
references: 22300715