University of Washington Seattle, WA, United States.
University of Michigan Ann Arbor, MI.
Pain. 2023 Feb 1;164(2):271-279. doi: 10.1097/j.pain.0000000000002748. Epub 2022 Aug 15.
The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 article by Wilbert "Bill" Fordyce, "Pain and suffering: what is the unit?" In this article, Fordyce suggested that pain-related disability and suffering should be viewed as "transdermal," as having causes both inside and outside the body. We consider Fordyce's article theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience-from nociception to multisensory indicators of safety or danger-can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and nonmedical providers to tackle chronic pain.
慢性疼痛的生物心理社会模型（BPS）旨在全面，纳入生物医学模型中忽略的心理和社会因素。尽管心理社会因素被认为对理解疼痛的行为和心理反应有很大影响，但这些因素通常被视为生物原因的疼痛体验的调节剂，而不是疼痛的同等贡献者。为了进一步推进 BPS 模型，我们重新审视了 Wilbert“Bill”Fordyce 于 1994 年撰写的一篇经典文章，“疼痛与痛苦：什么是单位？” 在这篇文章中，Fordyce 认为与疼痛相关的残疾和痛苦应该被视为“跨皮的”，因为其原因既有身体内部的，也有身体外部的。我们认为 Fordyce 的文章在理论上很重要，因为这个概念使我们能够比 BPS 模型的常规表述更充分地摆脱慢性疼痛的医学模型。它使我们能够在解释疼痛本身时将心理和社会因素与生物因素置于平等地位，并消除疼痛机制与疼痛意义之间的区别。大脑的显着网络现在提供了一个平台，各种对疼痛体验的影响——从伤害感受到安全或危险的多感觉指标——都可以在这个平台上整合，从而弥合了客观伤害感受机制与个人意义之间的差距。我们还认为，Fordyce 的文章在实践上很重要，因为这个概念将 BPS 模型扩展到临床接触之外，为社会、心理和生物干预的各个方面打开了大门，赋予了患者和非医疗提供者解决慢性疼痛的能力。
