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疼痛失调:作为疾病的慢性疼痛以及疼痛护理中互补性的必要性。

Maldynia: chronic pain as illness, and the need for complementarity in pain care.

作者信息

Giordano James

机构信息

Department of Medicine and Center for Clinical Bioethics, Georgetown University Medical Center, Washington, DC 20057, USA.

出版信息

Forsch Komplementmed. 2008 Oct;15(5):277-81. doi: 10.1159/000158572. Epub 2008 Oct 6.

Abstract

An expanding epistemology has generated enhanced understanding of the mechanistic basis and existential impact of pain as a complexity-based systems event, and compels the need to develop diagnostic and therapeutic approaches that reflect this progressive knowledge. The basic and clinical sciences, humanities and the experiential narratives of patients all contribute essential lenses through which we can examine and de-mystify the enigma of persistent pain. It is only through the combination of distinct domains of knowledge that we can both comprehend pain as a dysfunction of the dynamical, non-linear adaptability of the nervous system, and at the same time apprehend the manifestations of these changes within the networked-hierarchy of interacting systems that is the patient as person. These are concepts that are inherent to, and derived from complexity theory, and the use of a complexity-based model of pain may be important to fully reconcile the notions of disease and illness, and fit these within a more encompassing framework. Thus, the study of pain conjoins neuroscience to the burgeoning discourse of neurophilosophy, and in so doing, may allow a more thorough dialectical approach to addressing concepts of disease-illness, brain-mind, and ethical dimensions of care.

摘要

不断扩展的认识论使人们对疼痛作为一种基于复杂性的系统事件的机制基础和实际影响有了更深入的理解,并促使人们需要开发能够反映这一不断进步的知识的诊断和治疗方法。基础科学与临床科学、人文学科以及患者的经验叙述都提供了重要的视角,通过这些视角我们可以审视并揭开慢性疼痛之谜。只有通过结合不同的知识领域,我们才能将疼痛理解为神经系统动态、非线性适应性的功能障碍,同时理解这些变化在作为个体的患者的相互作用系统的网络层次结构中的表现。这些概念是复杂性理论所固有的,并且源自复杂性理论,使用基于复杂性的疼痛模型对于充分调和疾病和病症的概念,并将它们纳入一个更全面的框架可能很重要。因此,对疼痛的研究将神经科学与新兴的神经哲学话语结合起来,这样做可能会使我们在解决疾病 - 病症、脑 - 心以及护理伦理维度等概念时采用更全面的辩证方法。

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