Martin Sally, Daniel Clare, Williams Amanda C de C
Previously, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Pain Management Centre and Facial Pain Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Pain. 2014 Feb;155(2):349-355. doi: 10.1016/j.pain.2013.10.021. Epub 2013 Oct 23.
Neuropathic pain (NP) is not easy to understand for those with the diagnosis. Even in specialist medical services, explanation may not be given or may not be integrated with patients' existing beliefs about their conditions. We were curious about how people with NP conceptualised the problem. Web sites relevant to NP were used to recruit 79 people with NP. They were sampled using Q-methodology, which requires sorting according to degree of agreement or disagreement with diverse statements about NP, derived from the widest possible range of sources. The sets of sorted statements are analysed for factors which represent shared constructions. The four factors that we found differed in important ways: (1) identification of nerve damage as cause; (2) the necessity of identifying cause; (3) the acceptability of symptomatic treatment; (4) the existence or not of psychological influences; and (5) the usefulness of psychological treatment. The meaning of these factors was extended by participants' free comments: certain viewpoints showed associations with their medical and treatment histories and with the interference of pain with daily life. Overall, a biopsychosocial model of pain was only weakly represented, and no integrated model of pain emerged across the four different accounts. There was little reference to NP having been explained when the diagnosis was made. This study highlights the need for more accessible explanations of NP within and outside medical services if people with NP are to use their understanding of NP to help them manage their pain and reduce its impact on their lives.
对于那些被诊断患有神经病理性疼痛（NP）的人来说，这种疼痛并不容易理解。即使在专业医疗服务中，解释可能也不会给出，或者可能不会与患者对自身病情已有的认知相结合。我们好奇患有NP的人是如何理解这个问题的。利用与NP相关的网站招募了79名患有NP的人。他们采用Q方法进行抽样，该方法要求根据对源自尽可能广泛来源的关于NP的各种陈述的同意或不同意程度进行排序。对排序后的陈述集进行分析，以找出代表共同构建的因素。我们发现的四个因素在重要方面存在差异：（1）将神经损伤认定为病因；（2）确定病因的必要性；（3）对症治疗的可接受性；（4）心理影响的存在与否；（5）心理治疗的有用性。参与者的自由评论扩展了这些因素的含义：某些观点显示出与他们的病史、治疗史以及疼痛对日常生活的干扰之间的关联。总体而言，疼痛的生物心理社会模型仅得到微弱体现，并且在这四种不同的描述中没有出现统一的疼痛模型。当做出诊断时，几乎没有提及NP是否得到了解释。这项研究强调，如果患有NP的人要利用他们对NP的理解来帮助管理疼痛并减少其对生活的影响，那么在医疗服务内外都需要对NP进行更易于理解的解释。
