Dalton Jo Ann, Feuerstein Michael
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 U.S.A. Pain Treatment Center, Departments of Anesthesiology and Psychiatry, University of Rochester Medical Center, Rochester, NY 14642 U.S.A.
Pain. 1988 May;33(2):137-147. doi: 10.1016/0304-3959(88)90084-X.
Despite the presence of pathology in cancer pain, the pain experience in adult cancer patients cannot be totally explained by the extent of such pathology. Unlike chronic benign pain very little research on the role of biobehavioral factors has been conducted to help explain this paradox. The literature on the role of biobehavioral factors in the cancer pain experience is reviewed. A brief review of epidemiology and pathophysiology is presented. Following this, the biobehavioral literature was organized according to research on psychological characteristics and environmental factors. Research addressing affective, cognitive, behavioral and physiological reactions to pain was also discussed. Despite the paucity of studies, the review suggested the following: (1) personality factors do not appear to play a consistent role in the modulation of pain in cancer patients; (2) the work on environmental influences on cancer pain indicate a weak association between such factors as social network and pain intensity; (3) studies on affective state indicate minimal relationships to pain, and lastly, (4) studies on cognitive responses to pain in cancer patients and their influence on the pain experience have not been conducted. To date, in the areas where biobehavioral factors have been investigated, the findings appear modest. However, many potential variables, e.g., self-esteem, the role of family, the role of models, past or current work environments, social learning factors and responses to pain such as fear, somatization and reattribution have not been explored with cancer patients. While the influence of biobehavioral factors in adult cancer pain appear to be relatively modest, the literature is not extensive. Increased efforts at more precisely determining the input of such factors in cancer pain are warranted, particularly given the role of such variables in other recurrent and chronic pain states.
尽管癌症疼痛存在病理学因素，但成年癌症患者的疼痛体验并不能完全由这种病理学的程度来解释。与慢性良性疼痛不同，针对生物行为因素在解释这一矛盾中所起作用的研究非常少。本文对生物行为因素在癌症疼痛体验中的作用的相关文献进行了综述。首先简要介绍了流行病学和病理生理学。在此之后，根据对心理特征和环境因素的研究对生物行为学文献进行了整理。还讨论了针对疼痛的情感、认知、行为和生理反应的研究。尽管研究较少，但综述表明：（1）人格因素在癌症患者疼痛调节中似乎并未发挥一致的作用；（2）关于环境对癌症疼痛影响的研究表明，社交网络等因素与疼痛强度之间的关联较弱；（3）关于情感状态的研究表明其与疼痛的关系极小，最后，（4）尚未对癌症患者对疼痛的认知反应及其对疼痛体验的影响进行研究。迄今为止，在已对生物行为因素进行研究的领域，研究结果似乎并不显著。然而，许多潜在变量，如自尊、家庭的作用、榜样的作用、过去或当前的工作环境、社会学习因素以及对疼痛的反应，如恐惧、躯体化和重新归因等，尚未在癌症患者中进行探索。虽然生物行为因素在成年癌症疼痛中的影响似乎相对较小，但相关文献并不丰富。鉴于这些变量在其他复发性和慢性疼痛状态中的作用，有必要加大力度更精确地确定这些因素在癌症疼痛中的作用。
