McGrath P A
Child Health Research Institute, London, Ontario, Canada.
Arch Oral Biol. 1994;39 Suppl:55S-62S. doi: 10.1016/0003-9969(94)90189-9.
Interest in the assessment and management of pain increased dramatically after 1965, when the gate control theory was introduced. This increase is concurrent with enormous advances in our understanding of the plasticity and complexity of pain processing. New information about internal pain-inhibitory systems and the factors that trigger them has revolutionized traditional approaches to pain control. This article describes some of the new information on the factors that influence human pain perception, specifically the environmental and psychological factors that modify how pain is experienced. Pain is a complex, multidimensional perception that varies in quality, strength, duration, location, and unpleasantness. The strength and unpleasantness of pain is neither simply nor directly related to the nature and extent of tissue damage. Even newborn infants may experience different pains from the same stimulus, because of the differences in the situations in which it is administered. Pain experiences can range from an inability to perceive pain, regardless of the strength of stimulation, to the actual perception of pain in a limb that has been amputated. The perception of, expression of, and reaction to pain are influenced by genetic, developmental, familial, psychological, social and cultural variables. Psychological factors, such as the situational and emotional factors that exist when we experience pain, can profoundly alter the strength of these perceptions. Attention, understanding, control, expectations, and the aversive significance can affect pain perceptions. Consequently, the understanding of pain requires not only understanding of the nociceptive system, but recognition and control of the many environmental and psychological factors that modify human pain perceptions.
1965年闸门控制理论提出后，对疼痛评估与管理的关注急剧增加。这种增加与我们对疼痛处理可塑性和复杂性理解的巨大进步同时发生。关于内部疼痛抑制系统及其触发因素的新信息彻底改变了传统的疼痛控制方法。本文介绍了一些关于影响人类疼痛感知因素的新信息，特别是那些改变疼痛体验方式的环境和心理因素。疼痛是一种复杂的多维度感知，在性质、强度、持续时间、位置和不适感方面各不相同。疼痛的强度和不适感既不简单也不直接与组织损伤的性质和程度相关。即使是新生儿，由于给予相同刺激的情境不同，也可能体验到不同的疼痛。疼痛体验范围广泛，从无论刺激强度如何都无法感知疼痛，到对已截肢肢体的实际疼痛感知。对疼痛的感知、表达和反应受到遗传、发育、家庭、心理、社会和文化变量的影响。心理因素，比如我们经历疼痛时存在的情境和情感因素，能深刻改变这些感知的强度。注意力、理解、控制、期望和厌恶意义都会影响疼痛感知。因此，对疼痛的理解不仅需要了解伤害感受系统，还需要认识和控制许多改变人类疼痛感知的环境和心理因素。
