Penlington Chris, Urbanek Monika, Barker Sarah
Prim Dent J. 2019 Feb 19;7(4):24-29.
While pain has traditionally been understood within a medical model that equates pain to tissue damage or disease, this understanding is not consistent with everyday observations of pain or with clinical examples of persistent pain where there is often very little correlation between pain experienced and physical findings.
This article considers psychological and multidimensional theories of pain, which are described within the historical context within which they were developed, including behavioural, cognitive, contextual and functional theories.
Research into the multifactorial nature of persistent pain has tended to focus on mechanisms of pain development and maintenance or on the function of pain. psychological approaches, which have focused on mechanism traditionally use disability, mood and quality of life measures to assess outcome, claiming little or no impact on pain intensity itself. By contrast, functional approaches include an explicit goal of reducing pain intensity, which is therefore measured as a key treatment outcome.
Strong evidence exists from a range of sources of the important contribution of psychological and social factors to the experience of pain. However, evidence is still lacking about the specific mechanisms of change that are targeted by biopsychosocial interventions and about what treatment approach is likely to work best for whom.
虽然传统上疼痛是在一种将疼痛等同于组织损伤或疾病的医学模式中被理解的,但这种理解与对疼痛的日常观察或持续性疼痛的临床实例并不一致,在这些实例中,所经历的疼痛与身体检查结果之间往往几乎没有关联。
本文探讨了疼痛的心理学和多维度理论,这些理论是在其发展的历史背景中被描述的,包括行为理论、认知理论、情境理论和功能理论。
对持续性疼痛多因素性质的研究倾向于关注疼痛发展和维持的机制或疼痛的功能。传统上关注机制的心理学方法使用残疾、情绪和生活质量指标来评估结果,声称对疼痛强度本身几乎没有影响。相比之下,功能方法包括减轻疼痛强度这一明确目标,因此疼痛强度被作为关键治疗结果来衡量。
来自一系列来源的有力证据表明心理和社会因素对疼痛体验有重要影响。然而,关于生物心理社会干预所针对的具体变化机制以及哪种治疗方法可能最适合谁,仍然缺乏证据。