Chronic Pain, Chronic Demoralization, and the Role of Psychotherapy
Chronic Pain, Chronic Demoralization, and the Role of Psychotherapy
复制标题
DOI：
10.1007/s10879-016-9331-x
复制
发表时间：
2016-09-01
影响因子：
2
通讯作者：
Griffith, James L.
中科院分区：
文献类型：
--
作者：
de Figueiredo, John M.;Griffith, James L.
本文讨论了慢性疼痛患者的士气低落以及心理治疗在对抗慢性疼痛相关的慢性士气低落中的作用。强调了生物心理社会概念框架在理解慢性疼痛方面的优势。士气低落可以被视为痛苦和主观无能的结合。虽然患者经历的痛苦可能是可以理解的，并且与困境相称，但主观无能（与复原力截然相反）的同时发生及其升级为无助和绝望可能会导致自杀企图、要求安乐死或自杀身亡。慢性疼痛的复杂性及其与士气低落的关系可以从多个角度进行研究。生物、心理、社会和文化变量根据观察者的视角和观察背景发挥不同的作用。心理治疗在慢性疼痛中的作用可以从多种途径来看待，通过这些途径，语言、认知方式、行为、关系、对疼痛的态度和身体意识改变了疼痛神经基质内自上而下和自下而上的信息处理的相对影响。回顾了针对慢性疼痛患者开发的各种心理治疗干预措施，并为未来的研究提出了建议。
This article discusses demoralization in patients with chronic pain and the role of psychotherapy at combating chronic demoralization associated with chronic pain. The advantages of the biopsychosocial conceptual framework for the understanding of chronic pain are highlighted. Demoralization may be viewed as a combination of distress and subjective incompetence. While the distress experienced by the patient may be understandable and commensurate to the predicament, the co-occurrence of subjective incompetence (the polar opposite of resilience) and its escalation to helplessness, and hopelessness may result in suicidal attempts, demands for euthanasia, or death by suicide. The complexity of chronic pain and its relationship to demoralization may be examined from multiple perspectives. Biological, psychological, social and cultural variables play varying roles depending on the observer's perspective and the context of the observation. The role of psychotherapy in chronic pain may be viewed in terms of multiple pathways through which language, cognitive style, behavior, relationships, attitude towards pain, and awareness of the body modify the relative influences of top-down and bottom-up processing of information within the pain neuromatrix. Various psychotherapeutic interventions developed for patients with chronic pain are reviewed and recommendations are made for future research.