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Implications for our definitions of pain 对疼痛定义的启示
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70034-6
Barbara S. Shapiro

The International Association for the Study of Pain (IASP) definition of pain, by its emphasis on verbal communication, may contribute to the lack of recognition and treatment of pain in certain vulnerable groups of people. Additionally, the definition possesses an inherent Cartesian dualism, which may undermine effective treatment and contribute to stigmatization. Although the definition is valuable in that it addresses the irreducible subjectivity and lack of specificity of the pain experience, certain aspects deserve discussion and revision.

国际疼痛研究协会(IASP)对疼痛的定义强调语言交流,这可能会导致某些弱势群体缺乏对疼痛的认识和治疗。此外,该定义具有固有的笛卡尔二元论,这可能会破坏有效的治疗并导致污名化。虽然这个定义是有价值的,因为它解决了不可简化的主观性和缺乏特异性的疼痛经验,某些方面值得讨论和修订。
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引用次数: 6
Primary requirements for an ethical definition of pain 对疼痛进行道德定义的基本要求
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70033-4
Nance Cunningham

The current definition of pain adopted by the International Association for the Study of Pain (IASP) and the American Pain Society (APS) chapter of the IASP is unacceptable because its claims and consequences are inconsistent with the IASP's stated purpose. The definition's apparent claims that (1) only effective communication of pain brings pain into existence, and that (2) researchers and clinicians are merely objective evaluators of whether such communication has occurred are inconsistent with the lASP's purpose to improve care of patients with acute and chronic pain through attention to patients, to the relationship between them and their caregivers, and to social policy. The definition's success at rejecting the consequences of Cartesian dualism is only partial. The definition contributes to a lack of justice for nonverbal patients.

目前由国际疼痛研究协会(IASP)和美国疼痛协会(APS)分会采用的疼痛定义是不可接受的,因为它的主张和后果与IASP声明的目的不一致。该定义明显声称(1)只有有效的疼痛沟通才会带来疼痛,(2)研究人员和临床医生仅仅是这种沟通是否发生的客观评估者,这与lASP的目的不一致,即通过关注患者、患者与护理者之间的关系以及社会政策来改善对急性和慢性疼痛患者的护理。这个定义在拒绝笛卡儿二元论的结果上只是部分成功。这个定义导致了对非语言患者缺乏公正。
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引用次数: 11
The IASP definition captures the essence of pain experience IASP的定义抓住了疼痛体验的本质
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70036-X
Stuart W.G. Derbyshire

Cunningham has delivered a critique of the International Association for the Study of Pain (IASP) definition of pain from a very narrow standpoint. The reference to subjectivity and the multidimensional aspects of the definition were reduced to mean nothing more than an ability of “verbal report.” This indefensible straw man position was then demolished and replaced with a “signaling” theory of pain that was only minimally described. Cunningham's argument unfairly presents current medical practice as the enemy, oversimplifies the complexity of treating pain, and too easily dismisses our theoretical understanding of pain expressed through the IASP definition.

坎宁安从一个非常狭隘的角度对国际疼痛研究协会(IASP)对疼痛的定义提出了批评。对主观性的提及和定义的多维方面被简化为仅仅意味着“口头报告”的能力。这种站不住脚的稻草人立场随后被推翻,取而代之的是一种只有最低限度描述的疼痛“信号”理论。Cunningham的论点不公平地将当前的医疗实践视为敌人,过度简化了治疗疼痛的复杂性,并且太容易忽视我们通过IASP定义表达的对疼痛的理论理解。
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引用次数: 17
How facts matter 事实的重要性
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70031-0
Gary Varner

I agree with Bernard Rollin (in “Some Conceptual and Ethical Concerns About Current Views of Pain”) that it is implausible to hold that linguistic competence is a necessary condition for consciousness of pain. However, Rollin is incorrect to characterize this criterion as insulated from empirical disproof, because the best current theories of phenomenal consciousness that would support the criterion are themselves open to empirical disproof. Although I agree with Rollin that it would be implausible to deny that any nonhuman animals can feel pain, when we look closely at the relevant behavioral and neurophysiological evidence, we see that a good case can be made for saying that invertebrates (with the possible exception of cephalopods) probably cannot feel pain.

我同意Bernard Rollin(在《关于当前疼痛观点的一些概念和伦理关注》中)的观点,认为语言能力是疼痛意识的必要条件是不合理的。然而,Rollin将这一标准描述为与经验反证隔绝是不正确的,因为支持这一标准的当前最好的现象意识理论本身就是对经验反证开放的。虽然我同意Rollin的观点,否认任何非人类的动物都能感觉到疼痛是难以置信的,但当我们仔细观察相关的行为和神经生理学证据时,我们会发现,无脊椎动物(可能除了头足类动物)可能不能感觉到疼痛是有充分理由的。
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引用次数: 9
Competent treatment in the absence of a universal definition of pain 在缺乏对疼痛的普遍定义的情况下进行有效的治疗
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70035-8
Gary B. Rollman

Cunningham raises important issues about the ethical issues facing pain researchers and practitioners and the need to ensure that far more must be done to eliminate needless pain. I suggest that inadequate knowledge and lack of will are more of a problem than lack of agreement about a suitable definition of pain. In the absence of a universal definition, education and legislation are needed to ensure competent treatment, particularly for those whose capacity to communicate is limited.

坎宁安提出了关于疼痛研究人员和从业者面临的伦理问题的重要问题,以及确保必须做更多工作来消除不必要的疼痛的必要性。我认为,知识不足和缺乏意愿比对痛苦的适当定义缺乏共识更严重。在没有一个普遍定义的情况下,需要教育和立法来确保适当的治疗,特别是对那些沟通能力有限的人。
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引用次数: 1
On knowing an infant's pain 了解婴儿的痛苦
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70030-9
Kenneth D. Craig, Melanie A. Badali

Erroneous beliefs prevent effective management of infant pain, with the focus on self-report of the current definition of pain leading to neglect of nonverbal diagnostic information. Models of pain should consider not only experience but pain expression and how this is decoded and interpreted. The common-sense appeal of the belief that pain is a conscious experience is deficient, because there is no consensus on the nature of consciousness. Caregivers tend to self-reference and search for adult capacities for focal awareness in infants. The search seems to obfuscate our understanding of infant pain. Greater attention should be devoted to age-specific experience, the emotional distress of pain in infancy, and the important role of implicit information processing, or an impact for pain outside of focal attention.

错误的信念阻碍了对婴儿疼痛的有效管理,关注于当前疼痛定义的自我报告,导致忽视非语言诊断信息。疼痛模型不仅要考虑经验,还要考虑疼痛的表达以及如何解码和解释。认为疼痛是一种有意识的体验这种常识性诉求是有缺陷的,因为在意识的本质上还没有达成共识。照顾者倾向于自我参照和寻找成人能力的焦点意识在婴儿。这项研究似乎混淆了我们对婴儿疼痛的理解。更多的注意力应该投入到特定年龄的经验,婴儿期疼痛的情绪困扰,内隐信息加工的重要作用,或对焦点注意之外的疼痛的影响。
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引用次数: 4
mGluRs and opioid dependence mGluRs和阿片类药物依赖
Pub Date : 1999-06-01 DOI: 10.1016/S1082-3174(99)70049-8
Marian E. Fundytus , Terence J. Coderre
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引用次数: 5
Tolerance to morphine analgesia 吗啡镇痛耐受性
Pub Date : 1999-03-01 DOI: 10.1016/S1082-3174(99)70016-4
Anthony L. Vaccarino

There is a growing body of evidence that implicates the role of excitatory amino acids (EEAs), in particular the N-methyl-D-aspartate (NMDA) receptor, in the development of opioid tolerance. In their Focus article, Fundytus and Coderre have proposed a model of opioid tolerance that highlights the importance of metabotropic glutamate receptors (MGIuRs) in the contribution of EEAs to opioid tolerance. The authors conclude that drugs that target MGIuRs may provide a therapeutic tool for the prevention of tolerance to morphine analgesia in humans. However, although the authors provide clear evidence that MGIuRs play a critical role in the development of tolerance to morphine analgesia, we should practice caution in ascribing a single mechanism to a complex phenomenon. The aim of this Commentary is to examine some broader issues that surround tolerance to morphine analgesia to highlight the complexity of the problem.

越来越多的证据表明,兴奋性氨基酸(EEAs),特别是n -甲基- d -天冬氨酸(NMDA)受体,在阿片类药物耐受性的发展中起着重要作用。在他们的焦点文章中,Fundytus和Coderre提出了一个阿片类药物耐受性模型,强调了代谢性谷氨酸受体(MGIuRs)在EEAs对阿片类药物耐受性的贡献中的重要性。作者得出结论,针对mgiur的药物可能为预防人类对吗啡镇痛的耐受性提供一种治疗工具。然而,尽管作者提供了明确的证据表明MGIuRs在吗啡镇痛耐受的发展中起着关键作用,但我们应该谨慎地将单一机制归因于复杂现象。本评注的目的是研究围绕吗啡镇痛耐受性的一些更广泛的问题,以突出问题的复杂性。
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引用次数: 11
Response to commentaries 评论回复
Pub Date : 1999-03-01 DOI: 10.1016/S1082-3174(99)70047-4
Christine Miaskowski , Jon D. Levine
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引用次数: 0
Metabotropic glutamate receptors and opiate analgesia 代谢性谷氨酸受体与阿片类镇痛
Pub Date : 1999-03-01 DOI: 10.1016/S1082-3174(99)70015-2
Gordon Blackburn-Munro

Morphine acts at μ-opioid receptors within the brain and spinal cord to induce analgesia. However, tolerance and dependence are potentially undesirable side effects encountered with repeated opiate administration. Opiate withdrawal, the physical correlate of dependence, is involved in the negative reinforcement of opiate addiction. Recently, blockers of ionotropic subtypes of glutamate receptors have been suggested to have therapeutical potential for opiate withdrawal. Fundytus and Coderre have also shown that antagonism of metabotropic glutamate receptors (mGluRs) and δ-opioid receptors can separately alleviate the behavioral symptoms of withdrawal. They propose that mGluRs and δ-opioid receptors share intermediates and products of the same second messenger pathways as μ-opioid receptors, thereby enhancing the desensitization of this receptor. Thus, mGluRs appear to be involved in the development of opiate tolerance and dependence and may provide a key target for adjunct therapy with opiate analgesia.

吗啡作用于脑和脊髓内的μ-阿片受体,诱导镇痛。然而,耐受性和依赖性是反复服用阿片类药物时可能出现的不良副作用。阿片类药物戒断是阿片类药物依赖的生理相关,与阿片类药物成瘾的负强化有关。最近,谷氨酸受体的嗜离子性亚型阻滞剂被认为具有治疗阿片戒断的潜力。Fundytus和Coderre也表明,代谢性谷氨酸受体(mGluRs)和δ-阿片受体的拮抗作用可以分别缓解戒断行为症状。他们认为mGluRs和δ-阿片受体与μ-阿片受体共享相同的第二信使通路的中间体和产物,从而增强了该受体的脱敏性。因此,mGluRs似乎参与阿片耐受性和依赖性的发展,并可能为阿片镇痛辅助治疗提供关键靶点。
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引用次数: 1
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