Henry Ford Hospital Medical Journal


Patients with chronic pain who do not have significant physical symptoms present a characteristic clinical-psychological profile and show a high incidence of depressive traits (inactivity, depressive mood, anhedonia, and insomnia). This syndrome is termed pain-prone disorder and represents a form of masked depression par excellence. A series of 129 patients with pain of 6.9 years' duration was divided into three treatment groups. Two psychiatrists prescribed antidepressants systematically by promptly increasing doses and by alternating antidepressants if indicated. Significant improvement or freedom from pain was achieved in most patients who complied with treatment.

The third psychiatrist did not follow the systematic treatment protocol, and few of his patients improved. The high dropout rate, ascribed in part to the patients' unwillingness to be treated in a psychiatric clinic, was the major treatment problem. Since patients with chronic pain present in large numbers and loathe being referred to psychiatrists, their primary physicians should treat them with antidepressants in most cases. In view of their basic psychopathology, we are guarded in our expectation that these patients will be able to persist in treatment and maintain their improvement.