Melzack Ronald, Wall Patrick D, Ty Tony C
Department of Psychology, McGill University, 1205 Docteur Penfield Avenue, Montreal, Que. H3A 1B1 Canada Cerebral Functions Research Group, Department of Anatomy, University College London, Gower Street, London WC1E 6BT Great Britain Emergency Department, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Que. H3G 1A4 Canada.
Pain. 1982 Sep;14(1):33-43. doi: 10.1016/0304-3959(82)90078-1.
Features of acute pain were examined in patients at an emergency clinic. Patients who had severe, life-threatening injuries or who were agitated, drunk, or 'in shock' were excluded from the study. Of 138 patients who were alert, rational and coherent, 51 (37%) stated that they did not feel pain at the time of injury. The majority of these patients reported onset of pain within an hour of injury, although the delays were as long as 9 h or more in some patients. The predominant emotions of the patients were embarrassment at appearing careless or worry about loss of wages. None expressed any pleasure or indicated any prospect of gain as a result of the injury. The occurrence of delays in pain onset was related to the nature of the injury. Of 46 patients whose injuries were limited to skin (lacerations, cuts, abrasions, burns), 53% had a pain-free period. Of 86 patients with deep-tissue injuries (fractures, sprains, bruises, amputation of a finger, stabs and crushes), only 28% had a pain-free period. The McGill Pain Questionnaire was administered to patients who felt pain immediately after injury or after a delay, and revealed a normal distribution of sensory scores but very low affective scores compared to patients with chronic pain. The results indicate that the relationship between injury and pain is highly variable and complex.
在一家急诊诊所对患者的急性疼痛特征进行了检查。有严重的、危及生命的损伤或烦躁不安、醉酒或“休克”的患者被排除在研究之外。在138名警觉、理智且神志清醒的患者中，有51名（37%）表示在受伤时没有感到疼痛。这些患者中的大多数报告在受伤后一小时内开始疼痛，不过在一些患者中延迟长达9小时或更长时间。患者的主要情绪是因显得粗心而感到尴尬或担心工资损失。没有人表达任何愉悦之情，也没有人指出受伤会带来任何获益的可能性。疼痛发作延迟的发生与损伤的性质有关。在46名损伤仅限于皮肤（撕裂伤、割伤、擦伤、烧伤）的患者中，53%有一段无痛期。在86名有深部组织损伤（骨折、扭伤、瘀伤、手指截肢、刺伤和挤压伤）的患者中，只有28%有一段无痛期。对受伤后立即感到疼痛或延迟后感到疼痛的患者进行了麦吉尔疼痛问卷测试，结果显示感觉评分呈正态分布，但与慢性疼痛患者相比，情感评分非常低。结果表明，损伤与疼痛之间的关系高度可变且复杂。
