ABSTRACT
Pain is at the heart of interspecialty liaison. The physiological mechanisms sub serving sensations of pain are still incompletely understood. Among the neurotransmitters serotonin seems to be specifically involved in the natural pain-modifying arrangements. Acute, single-episode pain is an emergency signal rushing up the large-bore rapid-transit fibres, forcing open the transmission gate, and demanding an immediate response. Chronic, recurrent or perseverating pain is especially likely to exercise the skills of the psychiatrist in conjunction with his medical and surgical colleagues. Pain can only be diagnosed from the patient's behaviour, audible or visible, voluntary or involuntary. Childhood exposure to pain, personal or in a key relative may set a pattern of expectation and response. Direct reinforcement is applied in the extra kindness and attention from professionals and others contingent upon the expression of pain. Anxiety and depression each enhance pain, and in turn chronic physical illness and chronic pain lead to depression, and in some situations such as malignant disease, anxiety.
