Lipsitt D R
Psychiatr Clin North Am. 1987 Mar;10(1):69-85.
The special nature of pain in the face, head, and neck is not emphasized in the psychiatric literature on chronic pain. Although chronic pain of all types and locations share many features the psychological and symbolic significance of the head in the development of self-esteem, body image, and interpersonal relationships often confers special characteristics of pain on this area. As psychiatric consultation is not likely to be requested for patients with head, face, and neck pain in the absence of blatant "psychiatric" problems, it behooves the psychiatrist to exercise his liaison functions to enhance patient care in the inpatient setting and to help physicians recognize the utility of early psychiatric assessment on an outpatient basis with patients not yet requiring hospitalization. A collegial relationship with internists, dentists, neurologists, and surgeons facilitates the psychiatrist's role as a "team participant," often more effective in providing brief diagnostic, therapeutic, and management recommendations for patients who are usually not psychologically-minded and reluctant to pursue ongoing psychiatric treatment. However, the consultation-liaison psychiatrist can play an important role in expanding his colleagues' awareness of the multiple meanings of pain and the accompanying illness behavior, provide pedagogic help in the interviewing or history-taking process, offer suggestions about psychopharmacologic and other drug treatment, and serve as a resource for appropriate referral to sources of a variety of chronic pain treatments, including biofeedback, acupuncture, and family consultation. To fulfill both his consultative and liaison functions, it is incumbent upon the psychiatrist to be knowledgeable as well about nonpsychiatric aspects of pain of the head, face, and neck. We must acknowledge also how much we yet do not know: for example, why the psyche "chooses" a locus of pain in the body; how an external (or internal) stimulus is converted via cognitive, neuroendocrine, enzymatic, and other pathways to a somatic representation; the biochemistry of pain reduction by naturally occurring and synthetic drugs; and what characteristics distinguish the continuously creative individual who sustains persistent pain with barely an utterance from another who may "cave in" to seemingly trivial distress that results in total invalidism.
面部、头部和颈部疼痛的特殊性质在关于慢性疼痛的精神病学文献中未得到强调。尽管所有类型和部位的慢性疼痛都有许多共同特征，但头部在自尊、身体形象和人际关系发展中的心理和象征意义往往赋予了该区域疼痛的特殊特征。由于在没有明显“精神科”问题的情况下，不太可能对面部、头部和颈部疼痛的患者进行精神科会诊，因此精神科医生有责任发挥其联络作用，以加强住院患者的护理，并帮助医生认识到对尚未需要住院治疗的患者进行门诊早期精神科评估的作用。与内科医生、牙医、神经科医生和外科医生建立合作关系有助于精神科医生发挥“团队参与者”的作用，这通常能更有效地为那些通常没有心理意识且不愿接受持续精神科治疗的患者提供简短的诊断、治疗和管理建议。然而，会诊联络精神科医生在扩大同事对疼痛及伴随疾病行为的多种含义的认识、在问诊或病史采集过程中提供教学帮助、就心理药理学和其他药物治疗提供建议以及作为适当转诊至各种慢性疼痛治疗资源（包括生物反馈、针灸和家庭咨询）的资源方面可以发挥重要作用。为了履行其会诊和联络职能，精神科医生有必要对面部、头部和颈部疼痛的非精神科方面也有所了解。我们还必须承认我们还有很多未知的东西：例如，为什么心理会“选择”身体上的疼痛部位；外部（或内部）刺激如何通过认知、神经内分泌、酶和其他途径转化为躯体表现；天然和合成药物减轻疼痛的生物化学过程；以及如何区分那个持续承受剧痛却几乎不吭一声的具有持续创造力的个体和另一个可能会因看似微不足道的痛苦而“崩溃”并导致完全残疾的个体。
