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[致敏模型:向患者解释慢性疼痛的一种方法]

[The sensitization model: a method to explain chronic pain to a patient].

作者信息

van Wilgen C P, Keizer D

机构信息

Pijnkennis- en Behandelcentrum, afd. Anesthesiologie, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen.

出版信息

Ned Tijdschr Geneeskd. 2004 Dec 18;148(51):2535-8.

Abstract

Chronic pain is pain without a clear somatic substrate. As a result, patients with chronic pain often do not receive a clear diagnosis following a medical examination. In many patients, having pain without a proper explanation or diagnosis induces stress and the urge to search elsewhere for explanations and treatments. There is growing evidence that many chronic-pain syndromes, such as chronic low-back pain, whiplash and fibromyalgia, share the same pathogenesis: sensitisation of pain-modulating systems in the central nervous system at both spinal and supraspinal level. This central sensitisation is facilitated by numerous factors that contribute to the maintenance of pain in a way that differs from individual to individual. How sensitisation may develop and persist as a result of medical, psychological and social factors calls for research from the perspective of a bio-psycho-social model. If sensitisation is used to explain chronic pain to a patient and the patient understands the relation beween pain and the factors that play a role in the maintenance of the pain, this can lead to acceptation of a treatment learning to cope with these factors.

摘要

慢性疼痛是指没有明确躯体基础的疼痛。因此,慢性疼痛患者在接受医学检查后往往无法得到明确的诊断。在许多患者中,疼痛没有合理的解释或诊断会引发压力,促使他们到其他地方寻找解释和治疗方法。越来越多的证据表明,许多慢性疼痛综合征,如慢性下背痛、挥鞭伤和纤维肌痛,具有相同的发病机制:脊髓和脊髓上水平的中枢神经系统疼痛调节系统的致敏。这种中枢致敏由多种因素促成,这些因素以因人而异的方式维持疼痛。致敏如何因医学、心理和社会因素而发展并持续存在,这需要从生物-心理-社会模型的角度进行研究。如果用致敏向患者解释慢性疼痛,且患者理解疼痛与维持疼痛的因素之间的关系,这可能会使患者接受旨在学会应对这些因素的治疗。

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