Suffering: the contributions of persistent pain
Suffering: the contributions of persistent pain
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DOI：
10.1016/s0140-6736(99)01308-2
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发表时间：
1999-06-26
期刊：
影响因子：
168.9
通讯作者：
Gavrin, J
中科院分区：
文献类型：
--
作者：
Chapman, CR;Gavrin, J
疼痛是对一个人的生物完整性的感知威胁或损害。痛苦是一种对自我的严重威胁或伤害的感觉，当一个人对自己的期望与自己的行为或现状之间出现差异时，就会出现这种感觉。有些患者经历持续无法缓解的疼痛，因为疼痛改变了他们的身份。在生理层面上，慢性疼痛会促进长期的、破坏性的应激反应，其特征是神经内分泌失调、疲劳、烦躁、肌痛以及精神和身体机能受损。这种一系列的不适和功能限制可能会助长消极思维，并造成压力和残疾的恶性循环。认为一个人的疼痛本身无法控制的想法会导致压力。当这种循环使患者无法维持生产性工作、正常的家庭生活和支持性的社会互动时，患者就会遭受痛苦。尽管患者因多种原因而遭受痛苦，但医生可以通过控制疼痛来为预防或减轻痛苦做出重大贡献。对于大多数医生来说，痛苦是一个模糊的概念，其与疼痛的关系尚不清楚。这篇综述提供了一个医学上有用的痛苦概念，将痛苦与疼痛区分开来，通过将疼痛描述为压力源来解释疼痛与痛苦的贡献关系，并探讨这些想法对患者护理的影响。
Pain is a perceived threat or damage to one's biological integrity. Suffering is the perception of serious threat or damage to the self, and it emerges when a discrepancy develops between what one expected of one's self and what one does or is. Some patients who experience sustained unrelieved pain suffer because pain changes who they are. At a physiological level, chronic pain promotes an extended and destructive stress response characterised by neuroendocrine dysregulation, fatigue, dysphoria, myalgia, and impaired mental and physical performance. This constellation of discomforts and functional limitations can foster negative thinking and create a vicious cycle of stress and disability. The idea that one's pain is uncontrollable in itself leads to stress. Patients suffer when this cycle renders them incapable of sustaining productive work, a normal family life, and supportive social interactions. Although patients suffer for many reasons, the physician can contribute substantially to the prevention or relief of suffering by controlling pain. Suffering is a nebulous concept for most physicians, and its relation to pain is unclear. This review offers a medically useful concept of suffering that distinguishes it from pain, accounts for the contributory relation of pain to suffering by describing pain as a stressor, and explores the implications of these ideas for the care of patients.