Physiotherapy Research Unit and Musculoskeletal, Nuffield Orthopaedic Centre, Oxford, UK.
Disabil Rehabil. 2010;32(21):1722-32. doi: 10.3109/09638281003657857.
To explore how patients with persistent unexplained pain interpret and utilise the biopsychosocial model. This might have an impact on the outcome from treatment programmes that adopts a biopsychosocial approach.
We conducted three interviews with 20 patients attending a pain management programme for persistent unexplained back pain; prior to attending the course, immediately following the course and at 1 year. We used the methods of grounded theory.
Patients battled through several dialectic tensions in an attempt to legitimise their pain: First, patients wanted a medical diagnosis but also recognised that psychosocial factors contributed to their pain. Second, although the outward appearance of pain was important to legitimacy, it was also important not to appear 'too ill'. Third, meeting others with unexplained pain reinforced credibility, but patients also described how they were not 'like the others'. Finally, although holding on to one's self was important, patients also described an acceptance of loss.
These dialectic tensions are likely to have an impact on a person's decision to embrace the biopsychosocial model, and might therefore effect their outcome. Health care professionals should be sensitive to the cultural ambiguity of patients with persistent unexplained pain.
探讨持续性无法解释的疼痛患者如何解释和利用身心社会模型。这可能会对采用身心社会方法的治疗计划的结果产生影响。
我们对 20 名参加持续性无法解释的背部疼痛管理计划的患者进行了三次访谈；在参加课程之前、参加课程后立即以及 1 年后进行了访谈。我们使用了扎根理论的方法。
患者在试图使自己的疼痛合理化的过程中经历了几种辩证的紧张：首先，患者想要一个医学诊断，但也认识到心理社会因素对他们的疼痛有贡献。其次，尽管疼痛的外在表现对合法性很重要，但也重要的是不要显得“病得太厉害”。第三，与其他有无法解释的疼痛的人相遇增强了可信度，但患者也描述了他们如何“不像其他人”。最后，尽管坚持自己的立场很重要，但患者也描述了对失去的接受。
这些辩证的紧张可能会对一个人接受身心社会模型的决定产生影响，从而影响他们的结果。医疗保健专业人员应该对持续性无法解释的疼痛患者的文化模糊性保持敏感。
