Sullivan Erin, Hudson Jeremy
Erin Sullivan, CPNP, Department of Orthopaedic Surgery, Yawkey Center for Outpatient Care, Massachusetts General Hospital for Children, Boston. Jeremy Hudson, MSPT, Sollus Therapeutics LLC, 137 Newbury Street, Boston, MA.
Orthop Nurs. 2017 Mar/Apr;36(2):153-158. doi: 10.1097/NOR.0000000000000330.
The mind and the body are clearly intertwined in ways that are only now being discovered. In the orthopaedic world, injuries and diseases are often classified and described in a very organized, discrete fashion-The radius is fractured, the ACL or meniscus or rotator cuff is torn, the ankle is sprained, and/or the lumbar spine has a disc herniation. Although it is, in many ways, almost comforting to think about injuries or orthopaedic issues in this manner, what about the many patients who fail to fall into this classification? What about the thousands of patients with severe unexplained chronic pain or patients who just are not improving with the typical treatment algorithm. What about patients who present with multiple overlapping symptoms that do not fall into any of the classic diagnosis patterns? The mismatch between the actual health needs of typical patients and the standard acute medical response produces an immense waste of medical resources and incredible frustration for both the patient and the provider and creates a real risk that acute conditions will go untreated and become chronic. After more than a decade of traditional orthopaedic and musculoskeletal practice, its tremendous benefits as well as its limitations have become apparent. These limitations have sparked a search for integration of mind-body considerations to fill some of these gaps. Although this can prove to be quite challenging in today's healthcare world of maximizing volume and decreasing costs, it has proven to be an invaluable resource for both personal growth and patient and family satisfaction. The goals of this 2-part article are to dissect the relatively new concept of the mind-body connection in orthopaedics. The article aims to provide a framework that illustrates how the mind will predictably create objective observable phenomena in the body. The central focus of this framework is the role of the sympathetic nervous system and its effect on the chemistry, biomechanics, and appearance of various tissues in the body. Further identified are factors contributing to the aberrant emotional response as a means to empower practitioners and patients in recognizing the link between negative perception and observable symptoms. Our hope is to ultimately introduce a model of empowerment that when presented to a patient/family can produce a proactive response and, in turn, enhance current orthopaedic and pain management practices.
身心之间显然以目前才被发现的方式相互交织。在骨科领域，损伤和疾病通常以非常有条理、离散的方式进行分类和描述——桡骨骨折、前交叉韧带或半月板或肩袖撕裂、脚踝扭伤，和/或腰椎间盘突出。尽管在很多方面，以这种方式思考损伤或骨科问题几乎令人安心，但那些不符合这种分类的众多患者呢？那些患有严重不明原因慢性疼痛的数千名患者，或者那些没有按照典型治疗方案改善的患者呢？那些出现多种重叠症状但不属于任何经典诊断模式的患者呢？典型患者的实际健康需求与标准急性医疗反应之间的不匹配造成了医疗资源的巨大浪费，给患者和医疗服务提供者都带来了极大的挫败感，并产生了急性病症得不到治疗而变成慢性病的实际风险。经过十多年的传统骨科和肌肉骨骼实践，其巨大的益处以及局限性已经显现出来。这些局限性引发了对整合身心因素以填补其中一些空白的探索。尽管在当今以最大化诊疗量和降低成本为目标的医疗保健领域，这可能被证明极具挑战性，但它已被证明是个人成长以及患者和家庭满意度的宝贵资源。这篇分两部分的文章的目标是剖析骨科中相对较新的身心联系概念。本文旨在提供一个框架，说明思维如何可预测地在身体中产生客观可观察到的现象。这个框架的核心焦点是交感神经系统的作用及其对身体各种组织的化学、生物力学和外观的影响。还进一步确定了导致异常情绪反应的因素，以此作为一种手段，使从业者和患者能够认识到负面认知与可观察到的症状之间的联系。我们希望最终引入一种赋能模式，当呈现给患者/家庭时，这种模式能够产生积极主动的反应，进而改进当前的骨科和疼痛管理实践。
