Ballantyne Jane C, Sullivan Mark D
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.
J Pain. 2022 Oct;23(10):1651-1665. doi: 10.1016/j.jpain.2022.05.001. Epub 2022 May 13.
It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
直到20世纪，疼痛才被视为一种疾病。在此之前，它作为一种症状接受医学处理。将慢性疼痛（无论是身体上的还是大脑中的）宣布为一种疾病的动机包括增强其作为临床问题和研究重点的合理性，使其值得医疗保健和研究机构同样关注。但是疾病概念存在一个问题，即患有疾病倾向于采用医学解决方案，并且往往会减少患者的参与度。我们认为，慢性疼痛，尤其是慢性原发性疼痛（最近在《国际疾病分类第11版》中被指定为一级疼痛诊断），是一种习得状态，即使它与生物学因素相关，也并非不可改变。慢性疼痛有时是一种症状，有时可能是一种独立的疾病。但在这里，我们质疑将疾病作为重点对于许多慢性疼痛的价值，对于这些慢性疼痛，患者的参与至关重要，而且可能需要比疾病认定所暗示的更广泛的社会方法。观点：本文探讨将慢性疼痛认定为身体或大脑的疾病对患者是有益还是有害。疾病认定能否有助于推进治疗，以及实现未来的治疗突破是否需要它？或者它是否会使患者过度依赖医学干预并减少他们在康复过程中的参与度？
