Thielking Paul D
University of Utah Medical Center, Department of Psychiatry, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
Curr Pain Headache Rep. 2003 Aug;7(4):249-61. doi: 10.1007/s11916-003-0045-x.
Anxiety and pain can be understood with a multidimensional framework that accounts for somatic, emotional, cognitive, and behavioral aspects of these conditions. Patients who have cancer or treatment-related pain are more likely to be anxious than cancer patients without pain. Patients with cancer pain and anxiety cause difficult diagnostic dilemmas because some degree of anxiety is a normal response to having a severe medical illness. Furthermore, the somatic symptoms of anxiety often overlap with symptoms related to underlying disease processes or treatment effects. The degree of disruption in a patient's life often is the critical factor in distinguishing normal from maladaptive anxiety. Making an accurate diagnosis will help guide anxiety treatment and screening instruments can facilitate the recognition of those patients in need of further assessment. The relationship between pain and anxiety is complex and bidirectional, with interactions occurring on physiologic and psychologic levels. There are a variety of psychopharmacologic, psychotherapeutic, and complementary/alternative treatments available. A comprehensive approach to care includes these approaches in an individualized way. Terminal sedation is examined as a compassionate option for relieving intractable distress at the end of life.
焦虑和疼痛可以通过一个多维框架来理解，该框架考虑了这些状况的躯体、情绪、认知和行为方面。患有癌症或与治疗相关疼痛的患者比没有疼痛的癌症患者更有可能焦虑。患有癌症疼痛和焦虑的患者会导致诊断难题，因为一定程度的焦虑是对患有严重疾病的正常反应。此外，焦虑的躯体症状常常与潜在疾病过程或治疗效果相关的症状重叠。患者生活受到干扰的程度通常是区分正常焦虑与适应不良焦虑的关键因素。做出准确诊断将有助于指导焦虑症的治疗，而筛查工具可以促进对那些需要进一步评估的患者的识别。疼痛与焦虑之间的关系是复杂且双向的，在生理和心理层面都会发生相互作用。有多种心理药理学、心理治疗以及补充/替代治疗方法可供选择。全面的护理方法是以个体化方式将这些方法结合起来。临终镇静被视为一种在生命末期缓解顽固性痛苦的人道选择。
