从恐惧到安全:肌骨疼痛康复路线图。
From Fear to Safety: A Roadmap to Recovery From Musculoskeletal Pain.
机构信息
Curtin University, School of Allied Health, Faculty of Health Sciences, Perth, Western Australia, Australia.
Body Logic Physiotherapy Perth, Western Australia, Australia.
出版信息
Phys Ther. 2022 Feb 1;102(2). doi: 10.1093/ptj/pzab271.
Contemporary conceptualizations of pain emphasize its protective function. The meaning assigned to pain drives cognitive, emotional, and behavioral responses. When pain is threatening and a person lacks control over their pain experience, it can become distressing, self-perpetuating, and disabling. Although the pathway to disability is well established, the pathway to recovery is less researched and understood. This Perspective draws on recent data on the lived experience of people with pain-related fear to discuss both fear and safety-learning processes and their implications for recovery for people living with pain. Recovery is here defined as achievement of control over pain as well as improvement in functional capacity and quality of life. Based on the common-sense model, this Perspective proposes a framework utilizing Cognitive Functional Therapy to promote safety learning. A process is described in which experiential learning combined with "sense making" disrupts a person's unhelpful cognitive representation and behavioral and emotional response to pain, leading them on a journey to recovery. This framework incorporates principles of inhibitory processing that are fundamental to pain-related fear and safety learning.
当代对疼痛的概念强调了它的保护作用。疼痛所赋予的意义驱动着认知、情感和行为反应。当疼痛具有威胁性,且个体无法控制自己的疼痛体验时,它可能会变得痛苦、自我延续和致残。尽管残疾的途径已经得到很好的研究,但恢复的途径却研究得较少且理解得也较少。本观点借鉴了最近关于与疼痛相关的恐惧的个体体验的相关数据,讨论了恐惧和安全学习过程及其对疼痛患者康复的影响。这里的康复定义为对疼痛的控制以及功能能力和生活质量的改善。基于常识模型,本观点提出了一个利用认知功能疗法促进安全学习的框架。描述了一个过程,其中体验式学习与“意义建构”相结合,打破了个体对疼痛的无益认知表现,以及对疼痛的行为和情绪反应,引导他们走上康复之路。该框架包含了对疼痛相关恐惧和安全学习至关重要的抑制性加工原则。