Gullacksen Ann-Christine, Lidbeck Jan
School of Health and Society, Malmö University, Malmö, Sweden.
Pain Res Manag. 2004 Autumn;9(3):145-53. doi: 10.1155/2004/373479.
Previously, the subjective dimension of suffering from chronic pain has only infrequently been reported in the literature. However, in recent years qualitative psychosocial research has added new perspectives that describe how suffering from chronic pain affects life. The present paper refers to a qualitative study on the subjective experience of women diagnosed with chronic musculoskeletal pain. In a model for life adjustment, turning points and passages are described in three stages. In Stage I, there was increasing pain, disability, and physical and mental exhaustion. Alongside frustration and chaos there was a struggle to restore daily life; therefore, the picture of a healthy future was still intact. Acknowledging that pain may not be temporary marked the transition into Stage II, which was characterized by sorrow and loss, and the picture of the future faded. Once given an explanation of pain (a 'pain diagnosis'), a new understanding developed, with gradual improvement of coping skills. Adjustment eventually progressed into Stage III with the constructive use of past experiences, and competence and control increased. A new picture of the future emerged that could be handled. However, living with pain still required regular maintenance work. The outcome of qualitative investigations, including the one presented here, is discussed along with certain clinical implications. The following clinical implications are reviewed in the present study: distrust from health professionals may obstruct the adjustment process, prolong sick leave and hinder rehabilitation; providing the patient with a diagnosis (eg, an explanation of pain mechanisms) will facilitate life adjustment; acknowledging the individual experience of suffering from chronic pain will make concepts related to pain behaviour, secondary gain and sick role liable to question; and vocational rehabilitation measures should be harmonized with the actual stage of life adjustment.
此前，文献中很少报道慢性疼痛所带来痛苦的主观维度。然而，近年来定性社会心理研究带来了新的视角，描述了慢性疼痛的痛苦如何影响生活。本文提及一项关于被诊断患有慢性肌肉骨骼疼痛的女性主观体验的定性研究。在一个生活调整模型中，转折点和人生阶段被描述为三个阶段。在第一阶段，疼痛、残疾以及身心疲惫不断加剧。在挫折和混乱之中，人们努力恢复日常生活；因此，健康未来的图景依然完好。认识到疼痛可能并非暂时的，标志着进入第二阶段，其特征是悲伤和失落，未来的图景逐渐模糊。一旦得到疼痛的解释（“疼痛诊断”），就会形成新的认识，应对技巧也会逐渐提高。调整最终进入第三阶段，对过去经历进行建设性利用，能力和掌控感增强。一个可以应对的未来新图景出现了。然而，与疼痛共存仍需要定期的维持工作。包括本文所呈现的在内的定性研究结果将结合某些临床意义进行讨论。本研究将审视以下临床意义：医疗专业人员的不信任可能会阻碍调整过程、延长病假并妨碍康复；为患者提供诊断（例如，对疼痛机制的解释）将有助于生活调整；承认慢性疼痛患者的个体痛苦经历会使与疼痛行为、继发获益和患病角色相关的概念受到质疑；职业康复措施应与生活调整的实际阶段相协调。
