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超越生物医学模式:对慢性疼痛治疗方法的批判性综述及综合功能模型的提议

Beyond the Biomedical Model: A Critical Review of the Approach to Chronic Pain and the Proposal of an Integrated Functional Model.

作者信息

Pianese Luigi, Bordoni Bruno

机构信息

Physical Medicine and Rehabilitation, 3C+A Health and Rehabilitation, Roma, ITA.

Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA.

出版信息

Cureus. 2025 Jun 10;17(6):e85717. doi: 10.7759/cureus.85717. eCollection 2025 Jun.


DOI:10.7759/cureus.85717
PMID:40495824
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12151456/
Abstract

Chronic pain represents one of the most complex challenges of contemporary medicine. This narrative review critically analyzes the limitations of the traditional biomedical model in addressing chronic pain, highlighting how its reductionist vision is inadequate to effectively understand and treat this condition. The conceptual evolution of pain from a simple symptom to a codified "disease" is examined, highlighting the incongruities of this approach. The contribution of the bio-psycho-social model is discussed, recognizing its merits but also its applicative limits. Finally, the integration of the functional model, derived from functional medicine, is proposed as a complementary element that could fill the existing gaps, paying greater attention to nutritional and environmental factors and to the mesenchymal matrix as the biological "terrain" of chronic painful diseases. This review suggests the evolution towards a "bio-psycho-functional and social" model for a more complete understanding and management of chronic pain.

摘要

慢性疼痛是当代医学最复杂的挑战之一。这篇叙述性综述批判性地分析了传统生物医学模式在应对慢性疼痛方面的局限性,强调其还原论观点不足以有效理解和治疗这种病症。文中考察了疼痛从简单症状到被编纂为一种“疾病”的概念演变,突出了这种方法的不协调之处。讨论了生物心理社会模式的贡献,既认可其优点,也指出其应用局限性。最后,提出源自功能医学的功能模式作为一种补充要素,以填补现有空白,更加关注营养和环境因素以及间充质基质,将其视为慢性疼痛性疾病的生物学“土壤”。本综述建议朝着“生物心理功能和社会”模式发展,以便更全面地理解和管理慢性疼痛。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/88d78a61e3d8/cureus-0017-00000085717-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/213b76cdfdac/cureus-0017-00000085717-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/a6913c31f878/cureus-0017-00000085717-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/88d78a61e3d8/cureus-0017-00000085717-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/213b76cdfdac/cureus-0017-00000085717-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/a6913c31f878/cureus-0017-00000085717-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d018/12151456/88d78a61e3d8/cureus-0017-00000085717-i03.jpg

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本文引用的文献

[1]
An update on non-pharmacological interventions for pain relief.

Cell Rep Med. 2025-2-18

[2]
Analysis of Intestinal Bacterial Microbiota in Individuals with and without Chronic Low Back Pain.

Curr Issues Mol Biol. 2024-7-12

[3]
Impact of physical therapy techniques and common interventions on sleep quality in patients with chronic pain: A systematic review.

Sleep Med Rev. 2024-8

[4]
Fascial Nomenclature: Update 2024.

Cureus. 2024-2-11

[5]
A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience.

J Clin Med. 2023-11-14

[6]
Neural correlates of central pain sensitization in chronic low back pain: a resting-state fMRI study.

Neuroradiology. 2023-12

[7]
The Relation of Lifestyle with Inflammation at the Time of Diagnosis in Patients with Colorectal Cancer.

Cancers (Basel). 2023-8-28

[8]
Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a "Frozen Back"?

Diagnostics (Basel). 2023-4-16

[9]
The extracellular matrix and the immune system: A mutually dependent relationship.

Science. 2023-2-17

[10]
Grounding - The universal anti-inflammatory remedy.

Biomed J. 2023-2

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