Sternbach R A
Clin Orthop Relat Res. 1977 Nov-Dec(129):150-5. doi: 10.1097/00003086-197711000-00017.
Except in emergencies, the physician's obligation is not to relieve pain, but to diagnose and treat pathology. Psychological factors complicate organic pain, and make the diagnosis of "psychogenic" pain virtually impossible on the basis of psychological tests alone. In acute (short-term) pain, anti-anxiety agents are useful, but in chronic pain antidepressants are usually more appropriate. Continuing anxiolytic drugs past the acute stage tends to potentiate depressions. In addition to antidepressants, modalities which help in the management of chronic pain are physical therapy, transcutaneous electrical neurostimulation, use of weak analgesics on a "clock" rather than an "as needed" basis, and behavior modification. Explicit agreement on the features of the doctor--patient relationship is almost always essential for successfully managing these difficult and demanding patients.
除紧急情况外，医生的职责不是缓解疼痛，而是诊断和治疗病理状况。心理因素使器质性疼痛变得复杂，仅靠心理测试几乎无法确诊“心因性”疼痛。在急性（短期）疼痛中，抗焦虑药物有用，但在慢性疼痛中，抗抑郁药物通常更合适。在急性期过后继续使用抗焦虑药物往往会加重抑郁。除抗抑郁药物外，有助于慢性疼痛管理的方法有物理治疗、经皮电神经刺激、按“时钟”而非“按需”使用弱效镇痛药以及行为矫正。对于成功管理这些棘手且要求高的患者而言，就医患关系的特点达成明确共识几乎总是至关重要的。
