• Vicki Kalira, Glenn J Treisman, and Michael R Clark.
• Department of Psychiatry & Behavioral Sciences, Johns Hopkins Medicine, Osler 320, 600 North Wolfe Street, Baltimore, MD 21287-5371, USA.
• Curr Pain Headache Rep. 2013 Aug 1; 17 (8): 350.

AbstractPatients with chronic pain present a spectrum of complexity that can be overwhelming for the individual practitioner. These patients require thoughtful care and a comprehensive treatment plan. This complexity should be acknowledged, not avoided, and the patient should be engaged, not shunned. A practical approach will assist in developing expertise and proceeding empathically. The presence of a superimposed personality disorder significantly increases the difficulty of caring for these patients. Studies investigating the prevalence of borderline personality disorder in patients with chronic pain averaged 30 %, highlighting the importance of being able to effectively treat this patient population. Appropriate management of these patients should focus on a collaboration to practice productive behaviors despite intense emotional distress. Longitudinal research provides a foundation for an optimistic prognosis that can be enhanced with this rehabilitative approach.

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