Häuser W, Grandt D
Medizinische Klinik I des Klinikums Saarbrücken, Germany.
Schmerz. 2002 Dec;16(6):460-6. doi: 10.1007/s00482-002-0190-x.
Psychosomatics of visceral pain syndromes. From a psychosomatic point of view visceral pain syndromes can be classified into nociceptive (somatic and visceral) pain syndromes without and with maladaptive pain coping resp.psychic comorbidity, functional pain syndromes (typical symptom clusters without biochemical or structural abnormalities in clinical routine diagnostics) and psychic disorders with pain as main symptom. With regard to the etiology and the course of chronic inflammatory bowel diseases (IBD) as representatives of somatic pain syndromes and of irritable bowel syndrome/chronic pelvic pain as representatives of functional pain syndromes empirically validated psychosocial aspects are summarized: Personality traits, illness behavior, daily hassles, life events and psychic comorbidity and effects of psychotherapy. Psychosocial factors are decisive in the etiology and the course of functional pain syndromes as determinants of their severity (psychosomatic disease in a narrow sense). Psychosocial factors are not decisive for the etiology, but for the course of IBD (psychosomatic disease in a broader sense). Within general pain therapy of visceral pain syndromes a biopsychosocial approach should be applied right from the beginning (psychosomatic basic care). Within special pain therapy of visceral pain syndromes a qualified psychiatric - psychotherapeutic diagnostics and co-therapy should be mandatory.
内脏疼痛综合征的心身医学。从心身医学的角度来看，内脏疼痛综合征可分为无适应不良性疼痛应对或伴有精神共病的伤害感受性（躯体性和内脏性）疼痛综合征、功能性疼痛综合征（在临床常规诊断中无生化或结构异常的典型症状群）以及以疼痛为主要症状的精神障碍。关于作为躯体疼痛综合征代表的慢性炎症性肠病（IBD）以及作为功能性疼痛综合征代表的肠易激综合征/慢性盆腔疼痛的病因和病程，总结了经实证验证的社会心理方面：人格特质、疾病行为、日常琐事、生活事件、精神共病以及心理治疗的效果。社会心理因素作为功能性疼痛综合征严重程度的决定因素，在其病因和病程中起决定性作用（狭义的心身疾病）。社会心理因素对IBD的病因不起决定性作用，但对其病程起决定性作用（广义的心身疾病）。在内脏疼痛综合征的一般疼痛治疗中，应从一开始就采用生物心理社会方法（心身基础护理）。在内脏疼痛综合征的特殊疼痛治疗中，必须进行合格的精神科 - 心理治疗诊断和联合治疗。
