Götestam K G
Acta Psychiatr Scand. 1983 Apr;67(4):209-17. doi: 10.1111/j.1600-0447.1983.tb06734.x.
The treatment of chronic pain contains several problems such as ineffectiveness, side effects and drug dependence. The concepts of respondent and operant pain are introduced, together with a general operant learning model for analysis and treatment of psychological problems. To make a psychological analysis of pain, evidence for learned pain behaviour must be assessed, reinforcers for treatment revealed, goal behaviours set up, and support in the environment secured. In the further analysis, account must be taken to a) time pattern of pain, b) pain behaviour, c) reactions from the environment, d) pain activators, e) pain reducers, f) the effect of tension versus relaxation on pain, and g) changes in the family structure necessary because of the pain problem. A three-dimensional operant treatment programme for chronic pain is presented. It consists of 1) reduction of medication, 2) increase of activity, and 3) reduction of pain behaviour. Results, supporting the efficacy of the model, are presented.
慢性疼痛的治疗存在若干问题，如无效、副作用和药物依赖等。文中介绍了反应性疼痛和操作性疼痛的概念，以及用于分析和治疗心理问题的一般操作性学习模型。要对疼痛进行心理分析，必须评估习得性疼痛行为的证据，揭示治疗的强化因素，设定目标行为，并确保环境中的支持。在进一步分析中，必须考虑以下几点：a）疼痛的时间模式，b）疼痛行为，c）来自环境的反应，d）疼痛激活因素，e）疼痛减轻因素，f）紧张与放松对疼痛的影响，以及g）由于疼痛问题而必须对家庭结构做出的改变。本文提出了一个针对慢性疼痛的三维操作性治疗方案。它包括：1）减少药物用量，2）增加活动量，3）减少疼痛行为。文中给出了支持该模型有效性的结果。
