Patients with longstanding CPRP on chronic opioid therapy, who choose to participate in interdisciplinary rehabilitation that incorporates opioid withdrawal, can experience significant and sustained improvement in pain severity and functioning.

There is abundant clinical evidence that depression occurs with high frequency among chronic pain patients. When compared with other serious medical disorders, the prevalence of depression in chronic pain appears high. The fundamental reason for this association is unknown. Theories have attempted to explain the link between pain and depression in terms of psychologic mechanisms. Other theories highlight shared neurobiologic substrates. However, a comprehensive theory integrating biologic and psychologic viewpoints remains elusive. In this article, we draw on research on neuroplastic processes in corticolimbic structures to model the linkage between the sensory and affective domains of pain. Our hypothesis is based on kindling experiments in animals that elucidate the complex neurobiologic mechanisms that transduce exteroceptive and interoceptive stimuli into "memory" at the cellular/synaptic level. This experimental model has found application in the affective disorders to explain how a person's history of exposure to psychologic trauma configures the neurobiologic substrate for later-amplified pathologic response. In applying kindling research to pain, we begin by reviewing the literature on nociception-induced neuroplasticity at the corticolimbic level. We suggest that kindling and related models of neuroplasticity can be used to describe ways in which exposure to a noxious stimulus may, under certain conditions, lead to a sensitized corticolimbic state. This sensitized state can be described in terms of the kindling properties of amplification, spontaneity, neuroanatomic spreading, and cross-sensitization. A case example illustrates how these properties offer a neurobiologic framework for understanding the sensory/affective/behavioral symptom complex seen in a subset of chronic pain patients. These patients are characterized by atypical and treatment-refractory pain complaints, in association with disturbances of mood, sleep, energy, libido, memory/concentration, behavior, and stress intolerance. We introduce the term "limbically augmented pain syndrome" to describe this symptom complex.

The results of this study support the hypothesis that immediate posttreatment measures of physical and emotional functioning are favorable for patients with FM following multidisciplinary pain rehabilitation that incorporates withdrawal of analgesic medications.

These preliminary findings suggest a possible role for rTMS in treating FM.

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Interdisciplinary pain rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic pain patients.

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The traditional roles of psychologists and mental health therapists are challenged by the comprehensive treatment necessary for patients being treated in multidisciplinary pain rehabilitation programs (MPRPs). Mental health professionals within MPRPs provide direct clinical care but also guide the biopsychosocial model of pain management and cognitive-behavioral interventions for multiple disciplines. Illustrated by a case example of a patient who has complex chronic pain, this article discusses the biopsychosocial approach to pain treatment, structure of multidisciplinary care, major roles of mental health professionals in MPRPs, complexities of treating patients who have pain, and challenges in collaborating with multiple disciplines.