Stevens Bonnie
Lawrence S Bloomberg Faculty of Nursing, University of Toronto Toronto ON Canada.
Paediatr Neonatal Pain. 2021 Mar 27;3(3):101-105. doi: 10.1002/pne2.12047. eCollection 2021 Sep.
The complexity of the phenomenon of pain defies a simple and straightforward definition. Acute, chronic, nociplastic and neuropathic pain account for multiple pathologic mechanisms and forms of expression. Pain varies widely in intensity, duration and nature, often complicating description for those who are experiencing the pain and/ or those who are observing it. Assessment of pain in children can be challenging, especially in those who may be incapable of self-report report due to development immaturity or disability. In these children the responsibility of assessing pain often falls to the professional or lay care provider, whose knowledge, expertise and beliefs influence their judgements. The experience of pain includes not only the physiologic and behavioural indicators most frequently included in pain assessment measures but also encompasses the social and cognitive components that often go unrecognized. The 1979 IASP definition of pain has been praised for its brevity, simplicity and attention to the multidimensional nature of the phenomenon. It has also been criticized for ignoring mind-body interactions, disempowering and neglecting vulnerable populations, paying little attention to ethical dimensions, and excluding cognitive and social factors that are integral to the experience of pain. After four decades, the 1979 definition of pain and the accompanying notes were evaluated and revised by a 14-member IASP presidential task force with representation from basic and clinical research, geographical location and populations served (Pain, 2020, , 1976). These revisions resulted in decreasing the emphasis of pain associated with tissue damage in the definition, and, by removing the word 'described', allowing those who were nonverbal to be assessed using other validated pain indicators. Important revisions were also made to the Notes. The revisions that are most relevant for pain in children are discussed.
疼痛现象的复杂性使得难以给出一个简单直接的定义。急性、慢性、神经病理性疼痛和伤害感受性疼痛涉及多种病理机制和表现形式。疼痛在强度、持续时间和性质上差异很大，这常常给正在经历疼痛的人和/或观察疼痛的人描述疼痛带来困难。对儿童疼痛的评估可能具有挑战性，尤其是对于那些由于发育不成熟或残疾而无法自我报告的儿童。在这些儿童中，评估疼痛的责任往往落在专业或非专业护理人员身上，他们的知识、专业技能和信念会影响他们的判断。疼痛体验不仅包括疼痛评估措施中最常包含的生理和行为指标，还包括常常未被认识到的社会和认知成分。1979年国际疼痛研究协会（IASP）对疼痛的定义因其简洁、简单以及对该现象多维度性质的关注而受到赞誉。它也受到了批评，理由是忽视了身心相互作用、使弱势群体失去权力并被忽视、很少关注伦理层面，以及排除了疼痛体验中不可或缺的认知和社会因素。四十年后，一个由14名成员组成的IASP主席特别工作组对1979年的疼痛定义及相关注释进行了评估和修订，该工作组的成员来自基础和临床研究领域、不同地理位置以及所服务的人群（《疼痛》，2020年，第1976页）。这些修订导致在定义中减少了对与组织损伤相关疼痛的强调，并且通过去掉“描述”一词，使得可以使用其他经过验证的疼痛指标对无语言能力的人进行评估。对注释也进行了重要修订。本文讨论了与儿童疼痛最相关的修订内容。
