Schors R
Abteilung für Psychosomatische Medizin und Psychotherapie, Städtisches Krankenhaus München-Bogenhausen, Akademisches Lehrkrankenhaus.
Fortschr Med. 1990 Nov 10;108(32):613-5.
Two groups of patients with psychogenic pain syndromes were compared: in one group, pain was the sole major clinical complaint; in the other symptoms of depression also presented in addition to the pain. In both groups, the patient considers himself to be physically ill, despite the absence of organic findings. On the basis of the clinical examples, the psychodynamics of chronic pain is discussed with respect to primary and secondary epinosic gain, conscious and unconscious processes involving personal loss, proffered offences, desires and affects. In the absence of depressive symptoms, the psychological organization of pain can be understood as a substitution. Such a situation leads to a "stabilization" of the symptom and more prolonged chronicity than when depression presents at the same time, since in these patients, referral for psychotherapy is delayed.
一组中，疼痛是唯一主要的临床主诉；另一组中，除疼痛外还存在抑郁症状。在两组中，尽管没有器质性病变的发现，但患者都认为自己身患疾病。基于临床实例，从原发性和继发性疾病获益、涉及个人丧失、被指控的冒犯行为、欲望及情感的有意识和无意识过程等方面，探讨了慢性疼痛的心理动力学。在没有抑郁症状的情况下，疼痛的心理机制可被理解为一种替代。这种情况会导致症状“稳定”，且比同时伴有抑郁时的慢性病程更长，因为在这些患者中，寻求心理治疗的时间会延迟。
