Ojala Tapio, Häkkinen Arja, Karppinen Jaro, Sipilä Kirsi, Suutama Timo, Piirainen Arja
Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Department of Physical and Rehabilitation Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland.
Scand J Pain. 2015 Jan 1;6(1):33-40. doi: 10.1016/j.sjpain.2014.04.004.
Background Research has emphasised the essential role of psychosocial risk factors in chronic pain. In practice, pain is usually verified by identifying its physical cause. In patients without any distinct pathology, pain is easily defined as imaginary pain. The aim of this qualitative study was to explore the invisibility of chronic pain, from the patients' perspective. Methods Thirty-four participants with chronic pain were interviewed. The mean age of the participants was 48 years, and 19 of them were women. For 21 of the participants, the duration of pain was more than five years, and most of the participants had degenerative spinal pain. The transcribed interviews were analysed using Giorgi's four-phase phenomenological method. Results The participants' chronic pain was not necessarily believed by health care providers because of no identified pathology. The usual statements made by health care providers and family members indicated speculation, underrating, and denial of pain. The participants reported experience of feeling that they had been rejected by the health care and social security system, and this feeling had contributed to additional unnecessary mental health problems for the participants. As a result from the interviews, subthemes such as "Being disbelieved", "Adolescents' pain is also disbelieved", "Denying pain", "Underrating symptoms", "The pain is in your head", "Second-class citizen", "Lazy pain patient", and "False beliefs demand passivity" were identified. Conclusions In health care, pain without any obvious pathology may be considered to be imaginary pain. Despite the recommendations, to see chronic pain as a biopsychosocial experience, chronic pain is still regarded as a symptom of an underlying disease. Although the holistic approach is well known and recommended, it is applied too sparsely in clinical practice. Implications The Cartesian legacy, keeping the mind and body apart, lives strong in treatment of chronic pain despite recommendations. The biopsychosocial approach seems to be rhetoric.
背景 研究强调了社会心理风险因素在慢性疼痛中的重要作用。在实践中，疼痛通常通过确定其物理原因来证实。在没有任何明显病理状况的患者中，疼痛很容易被定义为想象中的疼痛。这项定性研究的目的是从患者的角度探讨慢性疼痛的隐匿性。方法 对34名慢性疼痛患者进行了访谈。参与者的平均年龄为48岁，其中19名是女性。21名参与者的疼痛持续时间超过五年，大多数参与者患有退行性脊柱疼痛。使用 Giorgi 的四阶段现象学方法对转录的访谈进行了分析。结果 由于没有确定的病理状况，医疗保健提供者不一定相信参与者的慢性疼痛。医疗保健提供者和家庭成员通常的表述表明他们对疼痛存在猜测、低估和否认。参与者报告称感觉自己被医疗保健和社会保障系统拒绝，这种感觉给他们带来了额外不必要的心理健康问题。通过访谈得出了“不被相信”“青少年的疼痛也不被相信”“否认疼痛”“低估症状”“疼痛在你脑子里”“二等公民”“懒惰的疼痛患者”以及“错误观念导致消极被动”等子主题。结论 在医疗保健中，没有任何明显病理状况的疼痛可能被视为想象中的疼痛。尽管有建议将慢性疼痛视为一种生物心理社会体验，但慢性疼痛仍被视为潜在疾病的症状。虽然整体方法广为人知并被推荐，但在临床实践中应用得太少。启示 笛卡尔将身心分离的传统观念在慢性疼痛治疗中仍然根深蒂固，尽管有相关建议。生物心理社会方法似乎只是空话。
