Pos R
Can Med Assoc J. 1974 Dec 7;111(11):1213-5.
Use of traditional stimulus-response models of pain leads to differentiation between organic and psychogenic pain, which is often not helpful, if not dangerous, in treating chronic pain. Pain does not simply reflect bodily damage but also complex psychological malfunctioning. Viewing chronic pain as an obsessional state may often help in treating the entire patient and prevent the physician from being obsessed with the patient's obsession. Psychological assessment of pain should focus on the role of psychological processes in the multifactorial causation of the illness causing the pain, notably their role in illness-proneness in general. Also, iatrogenic psychological distress, associatively precipitated psychological conflict and illness-perpetuating psychological processes should be looked for. A serious obstacle to progress with pain problems is not lack of hard data but conceptual confusion. Before medicine can meaningfully assess psychological factors in pain problems it must first learn to perceive psychological disturbances in medical and surgical patients.
使用传统的疼痛刺激-反应模型会导致对器质性疼痛和心因性疼痛进行区分，而这种区分在治疗慢性疼痛时往往没有帮助，甚至可能是危险的。疼痛不仅反映身体损伤，还反映复杂的心理功能失调。将慢性疼痛视为一种强迫状态往往有助于治疗整个患者，并防止医生陷入患者的困扰之中。对疼痛的心理评估应关注心理过程在导致疼痛的疾病的多因素病因中的作用，特别是它们在一般疾病易感性中的作用。此外，还应寻找医源性心理困扰、相关引发的心理冲突以及使疾病持续存在的心理过程。疼痛问题进展的一个严重障碍不是缺乏确凿的数据，而是概念上的混乱。在医学能够有意义地评估疼痛问题中的心理因素之前，它必须首先学会察觉内科和外科患者的心理障碍。
