Painter John R, Seres Joel L, Newman Richard I
Northwest Pain Center, 10615 S.E. Cherry Blossom Drive, Portland, Ore. 97216, U.S.A.
Pain. 1980 Feb;8(1):101-113. doi: 10.1016/0304-3959(80)90093-7.
Pain centers meet success in dealing with many cases of chronic pain which had been refractory to other therapies. Unfortunately, about one-fourth of all patients who initially do well begin to deteriorate shortly after completion, and within a few months have regressed to pre-treatment levels. In an effort to understand the causes of this regression, the authors surveyed patients who completed the program in 1977 by means of mail questionnaire. The 25 most successful patients were contrasted with an equal cohort of failures (i.e., patients who had met with initial success and subsequent regression). Correlations were also performed among indices of change and other variables. The failure group demonstrated less incentive for maintaining their gains, most continuing to receive financial compensation for their pain. Differences in attitude were revealed, with the failure group more likely to assume a dependent, passive stance. Depression was more characteristic of the failure group and may be causative with respect to deterioration. Most strinkingly, it appeared that the failure group had done little to change their environments, and continued to find reinforcement for pain behavior following discharge. The survey suggests the need for changes in the area of employment for injured workers, as well as further research in attitude measurement and attitude change. More aggressive treatment of depression might reduce the tendency toward regression, as would increased effort to change family dynamics that reward the patient for overt suffering.
疼痛治疗中心在处理许多对其他疗法无效的慢性疼痛病例方面取得了成功。不幸的是，大约四分之一最初治疗效果良好的患者在治疗结束后不久就开始恶化，几个月内就恢复到了治疗前的水平。为了了解这种病情复发的原因，作者通过邮寄问卷的方式对1977年完成该项目的患者进行了调查。将25名最成功的患者与同等数量的失败患者（即那些最初取得成功但随后病情复发的患者）进行了对比。还对变化指标和其他变量之间进行了相关性分析。失败组在维持治疗效果方面缺乏动力，大多数人仍因疼痛而继续获得经济补偿。态度上的差异也显现出来，失败组更倾向于采取依赖、被动的态度。抑郁在失败组中更为常见，可能是病情恶化的原因。最引人注目的是，失败组似乎几乎没有改变他们的环境，出院后仍继续为疼痛行为寻找强化因素。该调查表明，受伤工人的就业领域需要做出改变，同时在态度测量和态度改变方面还需要进一步研究。对抑郁症进行更积极的治疗可能会减少病情复发的趋势，改变家庭中因患者明显痛苦而给予奖励的动态关系的更多努力也会有同样的效果。
