Szer I S
From the Division of Pediatric Rheumatology, Children's Hospital of San Diego (Calif), USA.
Arch Pediatr Adolesc Med. 1996 Jul;150(7):740-7. doi: 10.1001/archpedi.1996.02170320086015.
Musculoskeletal pain is one of the most common pains of adolescence, along with headache and abdominal pain, and arthralgia is the single most common reason for referral to the pediatric rheumatologist. Not surprisingly, the pediatric rheumatologist is frequently called to distinguish organic from functional symptoms. During the past decade, the pediatric rheumatology community has been evaluating increasing numbers of adolescents and preadolescents who experience musculoskeletal symptoms presumably as a defense against emotional stress from achievement either in academic work or in sports. To complicate the challenge further, coexistent organic and psychologic disturbance is not rare. Clearly, organic illness does not protect a patient from emotional plan, and it may be most difficult to differentiate nonorganic pain in a patient with a known organic illness. Conversely, adolescents with organic illness may use their disease for secondary gain. Fear of misdiagnosis of physical illness as psychiatric and the notion that all of the patient's complaints should be explained by a unifying diagnosis cause diagnostic error in both psychogenic illness with physical manifestations and physical illness with psychogenic symptoms.
肌肉骨骼疼痛是青少年最常见的疼痛之一，与头痛和腹痛一样，关节痛是转诊至儿科风湿病专家处的最常见单一原因。毫不奇怪，儿科风湿病专家经常被要求区分器质性症状和功能性症状。在过去十年中，儿科风湿病学界评估的青少年和青春期前儿童数量不断增加，他们出现肌肉骨骼症状，可能是为了抵御学业或体育成绩带来的情绪压力。更复杂的是，并存的器质性和心理障碍并不罕见。显然，器质性疾病并不能使患者免受情绪困扰，在患有已知器质性疾病的患者中区分非器质性疼痛可能最为困难。相反，患有器质性疾病的青少年可能会利用他们的疾病获得继发性获益。担心将身体疾病误诊为精神疾病，以及认为患者所有的主诉都应由一个统一诊断来解释的观念，在既有躯体表现的心理性疾病和有心理症状的躯体疾病中都会导致诊断错误。
