Jimenez Xavier F
Chronic Pain Rehabilitation Program, Cleveland Clinic.
Psychodyn Psychiatry. 2019 Summer;47(2):167-182. doi: 10.1521/pdps.2019.47.2.167.
Chronic physical pain is prevalent condition and has gained considerable attention in the wake of the opioid crisis and epidemic. As a medical phenomenon, it has highlighted significant gaps in healthcare training, finances, clinical service, and administration. The psychodynamic determinants of pain symptoms or the need for analgesia are rarely considered in the medical management of this problem. The specific objective of this article is to offer a general psychodynamic understanding of chronic physical pain. As a psychodynamically oriented, medically informed psychiatrist practicing in a multidisciplinary pain management program, I propose a clinical construct of psychologically rich "parallel pains" to chronic physical pain, and that these pains inform important interpersonal issues dubbed "dynamic dilemmas." Chronic physical pain is defined, clinical examples are provided, and general implications are considered.
慢性身体疼痛是一种普遍存在的状况，在阿片类药物危机和流行之后受到了相当大的关注。作为一种医学现象，它凸显了医疗保健培训、资金、临床服务和管理方面的重大差距。在这个问题的医疗管理中，很少考虑疼痛症状的心理动力学决定因素或镇痛需求。本文的具体目标是提供对慢性身体疼痛的一般心理动力学理解。作为一名在多学科疼痛管理项目中执业的具有心理动力学导向、具备医学知识的精神科医生，我提出了一种临床上富有心理内涵的“平行疼痛”概念，将其与慢性身体疼痛相关联，并且这些疼痛揭示了被称为“动态困境”的重要人际问题。文中对慢性身体疼痛进行了定义，提供了临床实例，并考虑了一般影响。
