Manchikanti Laxmaiah, Fellows Bert, Singh Vijay
Pain Management Center of Paducah, 2831 Lone Oak Road, Paducah, KY 42003, USA.
Pain Physician. 2002 Jan;5(1):57-82.
There is no doubt that chronic pain is recognized as a biopsychosocial phenomenon in which biological, psychological, and social factors dynamically interact with each other. Thus, the role of psychological factors and understanding chronic, persistent disabling pain has been well recognized, but poorly understood. Approximately 1/2 to 2/3 of all patients diagnosed with chronic pain manifest to various levels of psychological distress. Chronic pain and psychological disorders are the two most common elements in the United States. Statistics show that, approximately 22% of Americans suffer from a diagnosable mental disorder in a given year. In addition, 28% of the American population suffers with chronic pain. Depression in chronic pain is the most common condition, followed by generalized anxiety disorder, somatization disorder, and drug dependence. However, psychogenic pain appears to be the least prevalent of all psychopathological issues. Chronic pain disability is a complex psychosocial economic phenomenon. There is no data in the literature with regards to treatment of personality disorders, anxiety disorders, and somatization disorders in managing chronic pain. In contrast, treatment of depression and the influence of treatment on outcomes have been studied to some extent. In conclusion, patients with chronic pain frequently have psychopathology - most often common depressive disorders, anxiety disorders, somatization disorders, drug dependence and occasionally personality disorders. This review discusses various issues involved with psychopathology in chronic pain including epidemiology; relationship of psychopathology to pain; influence of depression, generalized anxiety disorder, somatization, and personality disorders on chronic pain, along with diagnosis and management in interventional pain management.
毫无疑问，慢性疼痛被认为是一种生物心理社会现象，其中生物、心理和社会因素相互动态作用。因此，心理因素在理解慢性、持续性致残性疼痛中的作用已得到充分认识，但了解尚浅。在所有被诊断为慢性疼痛的患者中，约有1/2至2/3表现出不同程度的心理困扰。慢性疼痛和心理障碍是美国最常见的两种情况。统计数据显示，在特定年份，约22%的美国人患有可诊断的精神障碍。此外，28%的美国人口患有慢性疼痛。慢性疼痛患者中抑郁症最为常见，其次是广泛性焦虑症、躯体化障碍和药物依赖。然而，心因性疼痛似乎是所有精神病理问题中最不常见的。慢性疼痛致残是一种复杂的社会心理经济现象。文献中没有关于人格障碍、焦虑症和躯体化障碍在慢性疼痛管理中的治疗数据。相比之下，抑郁症的治疗及其对治疗结果的影响已得到一定程度的研究。总之，慢性疼痛患者常伴有精神病理学问题——最常见的是常见的抑郁症、焦虑症、躯体化障碍、药物依赖，偶尔还有人格障碍。本综述讨论了慢性疼痛中与精神病理学相关的各种问题，包括流行病学；精神病理学与疼痛的关系；抑郁症、广泛性焦虑症、躯体化和人格障碍对慢性疼痛的影响，以及介入性疼痛管理中的诊断和治疗。
