Schneider Markus
Interdisziplinäre Gesellschaft für orthopädische/unfallchirurgische und allgemeine Schmerztherapie (IGOST), Ravensburg, Deutschland.
, Trosdorfer Weg 14, 96120, Bischberg, Deutschland.
Orthopadie (Heidelb). 2025 Sep 12. doi: 10.1007/s00132-025-04702-y.
In the past 20-30 years, there has been a significant paradigm shift in understanding the causes of pain. Historically, the biomedical model, which emphasized a direct relationship between tissue damage and pain intensity, was dominant. However, it is increasingly recognized that pain perception is a highly complex system involving biological, psychological, and social factors, challenging the earlier understanding.
While intensive multimodal therapy provides sufficient time for patient education, this aspect is often neglected in outpatient settings. Key elements of outpatient pain neuroscience education (PNE) include improving the understanding of pain, differentiating between acute and chronic pain, explaining central and peripheral sensitization, addressing fear and avoidance behaviors, and demonstrating strategies to support endogenous pain inhibition.
The goal of education is to convey these highly complex pain physiology concepts in simple language, using images and metaphors that are accessible to the patient. PNE can positively influence not only the treatment of chronic pain but also preoperative education, thereby improving postoperative outcomes.
在过去20至30年里，人们对疼痛成因的理解发生了重大的范式转变。从历史上看，强调组织损伤与疼痛强度之间直接关系的生物医学模式占据主导地位。然而，人们越来越认识到疼痛感知是一个高度复杂的系统，涉及生物、心理和社会因素，这对早期的理解提出了挑战。
虽然强化多模式治疗为患者教育提供了充足的时间，但在门诊环境中这一方面往往被忽视。门诊疼痛神经科学教育（PNE）的关键要素包括增进对疼痛的理解、区分急性和慢性疼痛、解释中枢和外周敏化、解决恐惧和回避行为，以及展示支持内源性疼痛抑制的策略。
教育的目标是以简单的语言传达这些高度复杂的疼痛生理概念，使用患者能够理解的图像和隐喻。PNE不仅可以对慢性疼痛的治疗产生积极影响，还可以对术前教育产生积极影响，从而改善术后结果。
