Turk Dennis C
Department of Anesthesiology, University of Washington, Seattle, WA 98195, USA.
Reg Anesth Pain Med. 2003 Nov-Dec;28(6):573-9. doi: 10.1016/s1098-7339(03)00392-4.
Chronic pain is both prevalent and costly. Despite advances in understanding the anatomy, physiology, and biochemistry of nociception and development of potent analgesic agents and advanced technology, a significant number of people continue to experience pain and related disability. The perception of and response to pain are influenced by cognitive, affective, and behavioral factors as well as physical pathology. In this article, a selective review of research supporting the important contributions of psychologic factors is provided, a cognitive-behavioral perspective to understanding pain is presented, an integrative treatment and rehabilitation approach based on this perspective is described, and some of the evidence supporting the effectiveness of this treatment approach is summarized.
Chronic pain by definition persists over a long period-it is a chronic disease. Even the most sophisticated treatments are incapable of eliminating all pain for all pain sufferers. There is also tremendous variation in how patients respond to treatments provided and prescribed. Better treatment outcomes are likely to occur when the psychologic contributors and the physical factors involved are addressed. Moreover, a treatment approach based on the cognitive-behavioral perspective should help patients adapt to residual pain that remains after currently available treatments are undertaken. Thus cognitive-behavioral treatments should be viewed as important complements to more traditional pharmacological, physical, and surgical interventions.
慢性疼痛普遍存在且代价高昂。尽管在理解伤害感受的解剖学、生理学和生物化学方面取得了进展，并且开发出了强效镇痛剂和先进技术，但仍有相当数量的人持续遭受疼痛及相关残疾的困扰。对疼痛的感知和反应受到认知、情感、行为因素以及身体病理学的影响。本文对支持心理因素重要作用的研究进行了选择性综述，提出了一种从认知行为角度理解疼痛的观点，描述了基于该观点的综合治疗与康复方法，并总结了支持该治疗方法有效性的一些证据。
根据定义，慢性疼痛会长期持续——它是一种慢性疾病。即使是最先进的治疗方法也无法消除所有疼痛患者的全部疼痛。患者对所提供和规定的治疗的反应也存在巨大差异。当涉及的心理因素和身体因素都得到解决时，可能会取得更好的治疗效果。此外，基于认知行为观点的治疗方法应有助于患者适应在进行现有治疗后仍残留的疼痛。因此，认知行为治疗应被视为对更传统的药物、物理和手术干预的重要补充。
