Loeser J D
Department of Neurological Surgery, University of Washington, School of Medicine, Seattle 98195.
Theor Med. 1991 Sep;12(3):213-25. doi: 10.1007/BF00489607.
Chronic pain leads to individual suffering and to major costs for all developed countries. Previous studies suggest that both the incidence of disabling chronic pain and the amount of health care consumption due to chronic pain are rapidly increasing. Western medicine is not only often ineffective but may be one of the causes of this epidemic. This article will address the issue of chronic pain of unknown etiology and has the goals of: (1) identifying the factors which have led to our confusion about this topic, and (2) proposing alternative ways of conceptualizing chronic pain and its ensuing behaviors and social consequences. It is concluded that it is essential to discriminate between tissue damage, pain, suffering, pain behaviors, health care consumption, impairment and disability if one is to develop a meaningful conceptualization of the medical, social, economic and political problems of chronic pain. Successful treatment must be defined in behavioral terms such as restoration of normal activities. Disabling chronic pain is often a sign of overwhelming stress engendered by the individual's failure to cope with the demands of industrialized society.
慢性疼痛给个人带来痛苦，也给所有发达国家造成巨大成本。先前的研究表明，致残性慢性疼痛的发病率以及因慢性疼痛导致的医疗保健消耗都在迅速增加。西医不仅常常无效，而且可能是这场流行病的原因之一。本文将探讨病因不明的慢性疼痛问题，目标如下：（1）找出导致我们对该主题产生困惑的因素；（2）提出对慢性疼痛及其后续行为和社会后果进行概念化的替代方法。结论是，如果要对慢性疼痛的医学、社会、经济和政治问题形成有意义的概念，就必须区分组织损伤、疼痛、痛苦、疼痛行为、医疗保健消耗、损伤和残疾。成功的治疗必须用行为术语来定义，比如恢复正常活动。致残性慢性疼痛往往是个人无法应对工业化社会需求所产生的巨大压力的表现。
