Sternbach R A
J Human Stress. 1978 Sep;4(3):11-5. doi: 10.1080/0097840X.1978.9934990.
A small percentage of patients with persistent pain are sufficiently angry, demanding, and manipulative to require the negotiation of an explicit treatment and/or management contract. The very few studies in this field suggest that pain is both a function of and a stimulus to abnormal illness behavior, thus requiring special attention to therapeutic "ground rules." Treatment requires an unequivocal assertion by the patient that he wishes to get better and is willing to work at doing so; the specification of clearcut goals and the means of working towards them ("pacing behavior"); and the possible use of electrical neurostimulation and/or weak analgesics for pain control. Explicit understanding of mutual expectations and the patient's and doctor's "rights" is also helpful in fostering goodwill and desirable results.
一小部分持续疼痛的患者非常愤怒、苛求且善于操控，需要协商一份明确的治疗和/或管理合同。该领域极少的研究表明，疼痛既是异常疾病行为的一种表现，也是其刺激因素，因此需要特别关注治疗的“基本规则”。治疗需要患者明确断言自己希望好转并愿意为此努力；明确设定清晰的目标以及实现这些目标的方法（“调整行为”）；以及可能使用电神经刺激和/或弱效镇痛药来控制疼痛。明确相互期望以及患者和医生的“权利”，也有助于增进友好关系并取得理想的结果。
