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[安布鲁瓦兹·帕雷对幻肢痛的所谓最初描述。“值得赞赏且近乎不可思议之事”:“死肢与截肢部位的疼痛”]

[So-called initial description of phantom pain by Ambroise Paré. "Chose digne d'admiration et quasi incredible": the "douleur ès parties mortes et amputées"].

作者信息

Keil G

机构信息

Institut für Geschichte der Medizin, Universität Würzburg.

出版信息

Fortschr Med. 1990 Feb 10;108(4):62-6.

PMID:2179086
Abstract

In his (1552 (1554?) "Harquebusses and other guns" tractate the French surgeon, Ambroise Paré (1510-1590) described the post-amputation syndrome-considered to be the first description of this syndrome--which, on hermaneutic analysis, proves surprisingly complete: Paré differentiated pre-amputation pain ("la douleur ès parties mortes") from post-operative symptoms; he differentiated stump pain from phantom-limb sensations ("faux sentiments"), and he succeeded in distinguishing pain-free exteroceptive sensations--the so-called phantom-limb sensation--from phantom-limb pain proper ("la douleur ès parties amputées"). He characterised the psychogenic pain syndrome ("se plaigner fort"), described protracted, intermittent and delayed courses, as also exogenous modulating factors which--e.g. the weather ("les causes froides")--exacerbate the situation, or--e.g. massage--can also ameliorate it. Furthermore, he made use of psychological factors to combat pain, and rejected the use of multiple peripheral surgery to treat pain. He proposed two neurological models to explain the etiology of phantom-limb pain, one postulating peripheral changes in stump nerves, the other, involving memory, suggesting a cerebral origin, and locating algogenesis in the brain.

摘要

在其1552年(1554年?)的《火绳枪及其他火器》论文中,法国外科医生安布鲁瓦兹·帕雷(1510 - 1590)描述了截肢后综合征——被认为是对该综合征的首次描述——经诠释学分析,其描述惊人地完整:帕雷区分了截肢前疼痛(“残肢疼痛”)与术后症状;他区分了残端痛与幻肢感觉(“虚假感觉”),并且成功地将无痛的外感受性感觉——即所谓的幻肢感觉——与真正的幻肢痛(“截肢部位疼痛”)区分开来。他描述了心理性疼痛综合征(“剧烈疼痛”),阐述了病程迁延、间歇性及延迟性,还提及了外部调节因素,如天气(“寒冷因素”)会使情况恶化,而按摩等因素也可使其改善。此外,他利用心理因素对抗疼痛,并反对采用多次外周手术治疗疼痛。他提出了两种神经学模型来解释幻肢痛的病因,一种假设残端神经的外周变化,另一种涉及记忆,暗示其起源于大脑,并将疼痛产生定位于大脑。

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