如何从整个人的角度来看待痛苦

T. Wideman, Peter Stilwell
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摘要

很多时候,疼痛被简化为一种简单的疾病或受伤的症状——一种适合于鉴别诊断拼图的拼图。疼痛报告符合新出现的病理解剖图片被验证和相应的治疗。但许多报告并不符合这一图景,与持续疼痛相关的广泛耻辱最常见的是针对这些个体,他们的症状无法用已知的疼痛机制很好地解释。根本的问题是看不到痛苦的人或他们所经历的痛苦。本演讲旨在帮助参与者对疼痛有一个更全面的认识,更好地将其复杂性整合到临床实践中。参与者将被介绍到疼痛的多模态评估模型(MAP;Wideman等人,《临床疼痛杂志》2019;35(3): 212)。MAP提供了一个新的框架来理解疼痛和痛苦的基本主观性质,以及如何在临床实践中最好地解决这些问题。MAP旨在帮助临床医生首先将疼痛视为一种体验(如悲伤),这种体验可能符合也可能不符合特定的病理或诊断标准(如临床抑郁症)。MAP旨在通过提供为什么所有报告的疼痛都应该得到验证的基本原理,从而促进一种更富有同情心的疼痛管理方法,即使人们对疼痛知之甚少。以这种方式看待疼痛有助于强调倾听患者叙述报告的核心重要性,试图理解他们疼痛经历的意义和背景,并利用这种理解来帮助减轻痛苦。
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How to think about pain with the whole person in mind
Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience. This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.
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