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Human functional brain imaging 人脑功能成像
Pub Date : 1999-09-01 DOI: 10.1016/S1082-3174(99)70023-1
M. Catherine Bushnell , Gary H. Duncan , Robert K. Hofbauer

Human brain imaging studies have identified multiple brain regions activated during the experience of pain. Do these complex activation patterns lead to confusion and an “explanatory gap” between classical neurophysiology, psychology, and brain imaging? We propose the contrary, that human functional brain imaging studies can provide a bridge between neurophysiological research and the psychological concept of “pain.” Modern brain imaging techniques allow analysis of the relationship between brain activation patterns and various psychological percepts. However, an essential element in interpreting functional brain imaging observations is a robust psychophysical paradigm that permits the selective manipulation and measurement of individual perceptual features of pain. Functional brain imaging provides a new tool to facilitate our understanding of the complex cognitive, emotional, and sensory experience of pain. Nevertheless, this tool will add little to our knowledge if it is not used wisely.

人类大脑成像研究发现,在经历疼痛时,多个大脑区域被激活。这些复杂的激活模式是否会导致经典神经生理学、心理学和脑成像之间的混淆和“解释性鸿沟”?相反,我们认为人类功能性脑成像研究可以在神经生理学研究和“疼痛”的心理学概念之间架起一座桥梁。现代脑成像技术可以分析大脑激活模式和各种心理感知之间的关系。然而,解释功能性脑成像观察的一个基本要素是一个强大的心理物理范式,它允许选择性地操纵和测量个体疼痛的感知特征。功能性脑成像为我们理解疼痛的复杂认知、情感和感官体验提供了一种新的工具。然而,如果不明智地使用这个工具,它将不会增加我们的知识。
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引用次数: 5
All conscious experience, even pain, is “constructed” 所有有意识的体验,甚至包括痛苦,都是“建构”出来的。
Pub Date : 1999-09-01 DOI: 10.1016/S1082-3174(99)70021-8
David E. Becker

Although a constructivist view of consciousness is not an obvious one, consciousness theorists since William James have stressed the importance of selectivity and personal history for the creation of conscious experience. The conscious experience of pain is subject to the same processes. The nonlinear dynamic systems model approach introduced to the pain field by Chapman and Nakamura provides a promising overarching framework for multidisciplinary pain research, but does not directly deal with the problem of drawing strong inferences from functional brain imaging studies.

虽然意识的建构主义观点并不明显,但自威廉·詹姆斯(William James)以来的意识理论家强调了选择性和个人历史对意识经验创造的重要性。对疼痛的有意识体验也受制于同样的过程。由Chapman和Nakamura引入到疼痛领域的非线性动态系统模型方法为多学科疼痛研究提供了一个有前途的总体框架,但并没有直接处理从功能性脑成像研究中得出强有力推论的问题。
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引用次数: 0
A call for recognizing, legitimizing, and treating chronic visceral pain syndromes 呼吁认识、合法化和治疗慢性内脏疼痛综合征
Pub Date : 1999-09-01 DOI: 10.1016/S1082-3174(99)70025-5
Ursula Wesselmann

Interstitial cystitis (IC) shares many features with other chronic nonmalignant visceral pain syndromes. In clinical practice, much emphasis has been placed on finding a specific etiology and specific pathological markers for the disease and on identifying specific events that precipitated IC. This conceptualization has influenced clinical treatment approaches for IC and has not resulted in significant progress in this area so far. An additional approach is suggested, based on the conceptualization of three hypotheses: (1) a spectrum of different insults can lead to chronic visceral pain in patients suffering from IC, (2) different underlying pathogenic pain mechanisms may require different pain treatment strategies for patients diagnosed with IC, and (3) multiple different pathogenic pain mechanisms may coexist in the same patient requiring several different pain treatment strategies (perhaps concomitantly) to successfully treat chronic visceral pain associated with IC. This concept is likely to lead to new insights into the pathophysiological mechanisms of IC and to novel treatment avenues for patients suffering from IC and—in a broader view—also for patients with other chronic visceral pain syndromes.

间质性膀胱炎(IC)与其他慢性非恶性内脏疼痛综合征有许多共同特征。在临床实践中,重点放在寻找特定的病因和特定的病理标记物,以及确定导致IC的特定事件上。这种概念化影响了IC的临床治疗方法,但迄今为止尚未在该领域取得重大进展。根据三个假设的概念化,提出了另一种方法:(1)不同的损伤可导致IC患者的慢性内脏疼痛;(2)不同的潜在致病疼痛机制可能需要不同的IC患者疼痛治疗策略。(3)多种不同的致病性疼痛机制可能共存于同一患者,需要几种不同的疼痛治疗策略(可能同时)才能成功治疗与IC相关的慢性内脏疼痛。这一概念可能会对IC的病理生理机制产生新的见解,并为IC患者提供新的治疗途径,从更广泛的角度来看,也适用于其他慢性内脏疼痛综合征的患者。
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引用次数: 8
A neurologist's perspective on pain and consciousness 神经科医生对疼痛和意识的看法
Pub Date : 1999-09-01 DOI: 10.1016/S1082-3174(99)70020-6
Kenneth L. Casey

Although pain requires consciousness, the relationship between the two is variable. Some patients with impaired consciousness may have pain or aversive experiences that closely resemble pain. The variable relationship between pain and consciousness suggests that these phenomena are mediated by significantly different neural mechanisms. Consequently, the methods and theories that apply to consciousness research may have limited utility when applied to pain research.

虽然疼痛需要意识,但两者之间的关系是可变的。一些意识受损的患者可能会有疼痛或与疼痛非常相似的厌恶体验。疼痛和意识之间的可变关系表明,这些现象是由显著不同的神经机制介导的。因此,应用于意识研究的方法和理论在应用于疼痛研究时可能效用有限。
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引用次数: 1
Consciousness, complexity, and causality 意识、复杂性和因果关系
Pub Date : 1999-09-01 DOI: 10.1016/S1082-3174(99)70053-X
C. Richard Chapman , Yoshio Nakamura
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引用次数: 3
Reply to Varner and Kopelman 回复Varner和Kopelman
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70051-6
Bernard E. Rollin
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引用次数: 0
Consciousness, behavior, and clinical impact of the definition of pain 疼痛定义的意识、行为和临床影响
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70029-2
K.J.S. Anand , Cynthia Rovnaghi , Marlene Walden , John Churchill

When we exposed the inapplicability of the current definition of pain to neonatal experiences [8], objections to our viewpoint hinged on the absence of consciousness in such nonlinguistic beings [37]. The evidence reviewed in this focus article demonstrates the occurrence and manifestations of consciousness during evolution and human development. Consciousness is described in the full-term newborn, the premature neonate, and the developing human fetus. The clinical implications of ignoring its existence excludes these patients from the benefit of pain relief, promotes more lenient criteria for their participation as research subjects, and produces marked changes in professional attitudes and analgesic practices. We conclude that the definition of pain imposes more stringent standards for acknowledging the presence of pain in nonlinguistic beings and should be changed to include sources of evidence other than verbal self-report.

当我们揭示当前疼痛定义不适用于新生儿经历时[8],反对我们观点的理由是这些非语言生物缺乏意识[37]。在这篇重点文章中回顾的证据证明了在进化和人类发展过程中意识的发生和表现。意识在足月新生儿、早产儿和发育中的人类胎儿中都有描述。忽视其存在的临床意义使这些患者无法从疼痛缓解中获益,促进了他们作为研究对象参与的更宽松的标准,并在专业态度和镇痛实践中产生了显着变化。我们的结论是,疼痛的定义对承认非语言存在的疼痛施加了更严格的标准,应该改变为包括口头自我报告以外的证据来源。
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引用次数: 35
Some conceptual and ethical concerns about current views of pain 关于当前疼痛观的一些概念和伦理问题
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70050-4
Bernard E. Rollin
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引用次数: 13
Acknowledging pain in others 承认别人的痛苦
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70032-2
Loretta M. Kopelman

The recent International Association for the Study of Pain's (IASP) definition of pain apparently minimizes pain suffered by nonverbal individuals. This tendency is also reflected in recent studies about the care of patients and in social policies such as the so-called Baby Doe federal regulations for treatment of infants. It is important to counter this tendency to minimize pain by such means as giving clinicians a better education about (1) pain management; (2) decision-making standards such as the best interest, and moral issues about how to rank important medical goals; (3) research and practice guidelines relating to pain; and (4) encouraging health care, legal, and other institutions to adopt goals and means to address pain adequately.

最近国际疼痛研究协会(IASP)对疼痛的定义显然将非语言个体所遭受的疼痛最小化。这种趋势也反映在最近关于病人护理的研究和社会政策中,如所谓的婴儿治疗联邦条例。重要的是要通过给临床医生更好的关于(1)疼痛管理的教育来对抗这种最小化疼痛的趋势;(2)决策标准,如最佳利益,以及如何对重要医疗目标进行排序的道德问题;(3)与疼痛有关的研究和实践指南;(4)鼓励卫生保健、法律和其他机构采取适当的目标和手段来解决疼痛问题。
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引用次数: 3
Inclusion of the nonverbal patient 包括非语言病人
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70052-8
Nance Cunningham
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引用次数: 6
期刊
Pain Forum
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