Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Bern CH-3010, Switzerland Division of Psychosomatic and Psychotherapeutic Medicine, Lindenhofspital Bern, Bern CH-3012, Switzerland.
Pain. 2012 Sep;153(9):1847-1851. doi: 10.1016/j.pain.2012.05.006.
Patients with chronic pain disorders frequently show nondermatomal somatosensory deficits (NDSDs) that are considered to be functional. Typically, NDSDs show quadratomal or hemibody distribution ipsilateral to the areas of chronic pain. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition and the International Classification of Diseases, 10th revision, such functional somatosensory deficits are classified in the chapter "conversion disorder." Many publications also used the term "hysterical sensory loss." However, doubts are increasing about this one-sided psychiatric view. We aimed to better characterize the biopsychosocial factors associated with NDSDs. Therefore, we compared 2 groups of inpatients with chronic pain disorder, of whom 90 suffered from NDSDs and 90 did not. The patients with NDSDs all showed widespread somatosensory deficits with hemibody distribution. On logistic regression analysis, history of a prior physical trauma was positively predictive for patients with NDSDs. Personality disorder and adverse childhood experiences were positively predictive for the control group with chronic pain disorders without NDSDs. The frequencies of comorbid depression and anxiety disorder did not differ statistically between groups. In conclusion, pain patients with NDSDs are, psychopathologically, by no means more noticeable personalities than patients with chronic pain disorder without NDSDs. Similar to complex regional pain syndromes, we assume a multifactorial etiology of NDSDs, including stress. Based on our observations, terms like "hysteric" should not be applied any longer to patients with NDSDs who suffer from chronic pain.
慢性疼痛障碍患者常表现出非皮节体感缺失（NDSD），这些缺失被认为是功能性的。通常，NDSD 表现为与慢性疼痛区域同侧的四边形或半身分布。根据《精神障碍诊断与统计手册》第 4 版和《国际疾病分类》第 10 版，这种功能性体感缺失被归类于“转换障碍”一章。许多出版物也使用“癔症性感觉缺失”一词。然而，这种片面的精神观点正受到越来越多的质疑。我们旨在更好地描述与 NDSD 相关的生物心理社会因素。因此，我们比较了两组慢性疼痛障碍住院患者，其中 90 名患有 NDSD，90 名没有。患有 NDSD 的患者均表现出广泛的半身分布体感缺失。在逻辑回归分析中，既往躯体创伤史对 NDSD 患者具有正向预测作用。人格障碍和不良童年经历对无 NDSD 的慢性疼痛障碍对照组具有正向预测作用。两组患者的共患抑郁和焦虑障碍频率无统计学差异。总之，患有 NDSD 的慢性疼痛患者在心理病理上绝不是比没有 NDSD 的慢性疼痛障碍患者更引人注目的人格。与复杂区域疼痛综合征类似，我们假设 NDSD 的病因是多因素的，包括压力。基于我们的观察，不应再将患有慢性疼痛的 NDSD 患者称为“癔症”。
