Tanikawa Hirotaka
Department of Orthopedics, Azumi General Hospital.
Nihon Rinsho. 2009 Sep;67(9):1783-90.
Several diseases, including the functional somatic syndromes (FSS), are characterized by pain involving locomotive structures. These disorders include low back pain, neck-shoulder-arm syndrome and fibromyalgia. FSS patients are convinced that their illness is not a psychosomatic disorder, being instead a bodily disease. Therefore, physicians such as orthopedic surgeons play an important role in supporting patients suffering from FSS with locomotive pain, because these patients expect their physicians to treat them for a physical, rather than a psychological disorder. The author investigated the patient-doctor relationship in the examination room of a hospital, and designated pain combined with a depressive state characterized by agitation and helplessness, a common complaint made by FSS and psychosomatic disorder patients, 'painful depression'. Pain and depression influence each other and trigger a vicious downward spiral termed the 'pain-depression deflation spiral'. Generally, orthopedic surgeons can achieve good relationships with FSS patients with locomotive structure pain, despite suspicion of psycho-social factors. It is concluded that physical examinations and treatments by orthopedic surgeons, conducting physical examinations only, can serve as a very good psychosomatic approach to painful depression/FSS patients.
包括功能性躯体综合征（FSS）在内的几种疾病，其特征是涉及运动结构的疼痛。这些病症包括腰痛、颈肩臂综合征和纤维肌痛。FSS患者坚信他们的疾病不是身心失调，而是身体疾病。因此，骨科医生等医生在支持患有运动性疼痛的FSS患者方面发挥着重要作用，因为这些患者期望医生为他们治疗身体疾病，而非心理疾病。作者在一家医院的检查室调查了医患关系，并将FSS和身心失调患者常见的伴有以烦躁和无助为特征的抑郁状态的疼痛定义为“疼痛性抑郁”。疼痛和抑郁相互影响，引发一种恶性循环，即“疼痛-抑郁螺旋式下降”。一般来说，尽管怀疑存在心理社会因素，但骨科医生仍能与患有运动结构疼痛的FSS患者建立良好关系。得出的结论是，仅进行体格检查的骨科医生的体格检查和治疗，可作为治疗疼痛性抑郁/FSS患者的一种非常好的身心治疗方法。
