Psychological functional system of refractory nononcologic chronic pain treated with intrathecal pump analgesia

Abstract

Introduction: Chronic pain management is controversial. In Cuba, two patients with refractory nononcologic chronic pain have been treated with intrathecal pump analgesia, cases in which clinical indicators of short-term improvement were observed; however, there are no reports of what happens in the psychological functional system of these patients in the long term.

Clinical case(s): Two female patients with refractory nononcologic chronic pain (63 years old and 47 years old) were implanted subcutaneously with a programmable pump (sincromed II) for administering intrathecal analgesia, at Centro Internacional de Restauración Neurológica (CIREN). An evaluation of the characterological, interactional and psychodynamic dimensions was performed before and two years after treatment. Case 1: pre- and post-low depression, pre-high and post-moderate anxiety, pre-average and post-high self-esteem, pre-10 and post-2 in pain intensity, pre-0.9 and post-4.9 in pain–activity–interpersonal relationships, pre–little use and post–mixed use in coping, pre-1.9 and post-2.3 in lifestyle, pre- and post-low suicidal risk. Case 2: pre-low and post-low depression, pre-moderate and post-low anxiety; pre-low and post-average self-esteem, pre-10 and post-3 in pain intensity, pre-0 and post-4.0 in pain–activity–interpersonal relationships, pre–little use and post–mixed use in coping, pre-1.3 and post-2.0 in lifestyle, pre-low and post-low suicidal risk.

Conclusions: Analgesia by programmable intrathecal pump has favorable effects on the psychological functional system of patients with long-term refractory nononcologic chronic pain. Some particularities in the characterological and interactional dimension should be assisted using psychotherapeutic treatment strategies.