Chronic idiopathic pain syndrome.

Chronic idiopathic pain syndrome is a common, disabling and costly condition. It is believed to be of psychological origin but may involve both cerebral and peripheral physiological mechanisms. It is often associated with depression. Its assessment and management need to be multifactorial, i.e., medical, psychosocial and psychiatric. A thorough initial medical assessment is crucially important in order to identify any organic contributory factors and to gain the patient's trust. It is also essential to carry out a psychosocial and psychiatric assessment so as to evaluate the role of psychological and socioeconomic factors and establish whether a diagnosable psychiatric disorder is present. The latter is most likely to be a depressive, anxiety, or somatoform disorder. If the medical assessment fails to come up with a plausible organic explanation for the patient's pain, he or she should be told so clearly. The patient should be told that the goal of the treatment is not to cure the pain but to help him/her improve his/her functioning and sense of control over pain and life generally. The type of management most likely to succeed in this goal is one that is multifactorial and comprehensive rather than focused on one treatment modality only.