Vyshka Gentian
Department of Biomedical and Experimental, Faculty of Medicine, University of Medicine, Tirana 1005, Albania.
World J Clin Cases. 2022 Sep 26;10(27):9550-9555. doi: 10.12998/wjcc.v10.i27.9550.
Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.
疼痛性疾病可能是人们寻求医疗建议和帮助的最常见原因之一。尽管疼痛在精神科患者中很常见，但临床医生通常将疼痛的存在与潜在的精神障碍区分开来，并淡化其重要性，主要致力于控制精神症状。作为一种感觉模态，疼痛的存在及其重要性引发了大量学术研究。笛卡尔方法论以机械论的形式看待所有模态的感觉，这实际上听起来已经过时了。然而，几个世纪以来，作者们一直面临着困扰学者们的同样困境。我们假设很大一部分感觉输入可能是扭曲感知的产生者，进而导致精神病理学。听觉和视觉幻觉就是无可争议的例子。躯体感觉性幻觉也存在，但疼痛几乎不值得这样的称谓。然而，慢性疼痛与精神疾病共病是一个需要解释的现实。止痛药对治疗精神疾病无效，抗精神病药物对缓解疼痛作用甚微，甚至可能毫无作用。药物治疗方法打开了一扇希望之门，却关上了许多其他门，而临床医生仍面临着疼痛与心理健康问题共病的高发生率。然而，试图将改变的身体图式（比如在幻肢痛中可能出现的扭曲）与躯体妄想联系起来，可以简化所有这些困境，事实上，心理生理学的范畴可能比想象的更大。
