Reply to Goebel and Molloy.
Reply to Goebel and Molloy.
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回复戈贝尔和莫洛伊。
DOI：
10.1097/j.pain.0000000000002132
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发表时间：
2021
期刊：
影响因子：
7.4
通讯作者：
Häuser,Winfried
中科院分区：
文献类型：
--
作者：
Baranowski,Andrew;Messelink,Bert;Wesselmann,Ursula;Häuser,Winfried
Drs Goebel和Molloy 2的信再次说明了对原发性和继发性疼痛概念的有效性和临床实用性的持续关注，并且与我们的文章中提出的一致。[3]该团队因其在复杂区域疼痛方面的工作而闻名和受人尊敬，根据ICD-11，这种情况将被视为“原发性”疼痛综合征。英国的指南由Goebel博士领导。5.关于继发性疼痛和原发性疼痛的关系有很多问题，例如：如果“原因”消失了，继发性疼痛会变成原发性疼痛吗？在我们的专业领域，考虑膀胱疼痛综合征，这种情况与早期感染有关，但不再存在。复发性念珠菌感染和慢性外阴阴道疼痛之间的联系仍在研究中，外阴疼痛在原发性和继发性疼痛的背景下应如何标记？1是否有这样一种东西作为一个“原发性疼痛”没有一个“原因”，也许我们只是没有找到原因？什么诱发因素，遗传学和表观遗传学，以及未能记住索引事件，或多个阈下索引events 7，8？因此，也可以提出这样的问题，即当在后期阶段找到原因时，原发性疼痛是否会成为继发性疼痛，这取决于例如所进行的诊断。原因也可能在一段时间内不明显，后来变得明显，然后提供治疗的机会。一个典型的例子是在某些胃溃疡和十二指肠溃疡的背景下发现幽门螺杆菌感染。6
The letter by Drs Goebel and Molloy2 once more illustrates the ongoing concerns on the validity and clinical utility of the concept of primary and secondary pain and is consistent, as raised in our article. 3 This team is well known and respected for their work around complex regional pain, a condition that under the ICD-11 would be considered a “primary” pain syndrome. The UK guidelines were led by Dr Goebel. 5 There are many questions around the relationship of secondary pain and primary pain, for instance: Can secondary pain become primary if the “cause” has gone? In our area of expertise, consider bladder pain syndromes, where the condition was associated with an infection in the early days but is no longer present. How should vulvodynia, where the association between recurrent candida infections and chronic vulvovaginal pain is still being investigated, be labelled in the context of primary and secondary pain? 1Is there such a thing as a “primary pain” without a “cause,” maybe we just have not found the cause? What about predisposing factors, genetics and epigenetics, as well as a failure to remember the index event, or multiple subliminal index events7, 8? Thus, the question can also be raised if primary pain can become secondary, when in a later phase a cause is found. This depends, for instance, on the diagnostics performed. Also causes can be obscure for some time and later on became visible and then offer opportunities for treatment. A classic example is the discovery of Helicobacter pylori infections in the context of some gastric and duodenal ulcers. 6