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疼痛

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疼痛
一位妇女在抽血时表情痛苦
分类和外部资源
医学专科神经内科
ICD-10R52
ICD-9-CM338
DiseasesDB9503
MedlinePlus002164
MeSHD010146

身体的疼痛(pain)指通常由身体损伤、病患或不良的外部刺激所引起的不舒服感觉。出于临床研究的需要,国际疼痛研究国际疼痛研究协会英语International Association for the Study of Pain将疼痛定义为“由真正存在或潜在的身体组织损伤所引起的不舒服知觉和心理感觉”。[1][2]

疼痛是主观的感觉,早于1968年疼痛处理专家马戈·麦加费利英语Margo McCaffery首次提出一个在护理学界普遍使用的定义:“一个人说感到痛,这就是痛;他说痛仍在,痛就仍在。”(原文:Pain is whatever the experiencing person says it is, existing whenever he says it does)[3][4]

身体疼痛是看医生的主要原因;在美国,有一半看医生的人是因为疼痛,是最普遍的原因。[5]疼痛也是大部分病患的症状,可根据维持时间、强度、种类(如火烧、针刺般等)、位置等来诊断。通常疼痛会自然消退,或通过简单的止痛处理后消退,这可称作“急性”疼痛。但有时疼痛本身已是一种病患,如慢性疼痛。近年痛症引起了不同学科专家的关注,如药理学神经生物学护理学物理治疗心理学,并形成了疼痛处理这门在麻醉学、物理治疗、神经学精神科等专科之下的附属专科[6]

人体的痛觉神经有六种,但科学上纪录有人无法感受痛楚,这种病是先天性无痛症,英文简称为“CIP”。

用语区分

疼痛指身体的疼痛,是主观、有意识的感觉。而痛觉则指感受器周围神经系统脊髓受有害刺激而引起的无意识活动[7]

分类

痛觉感受器英语nociceptor受到化学、热力或撞击等可损伤身体组织的刺激就可能会产生疼痛。若神经系统由病患或损伤而受损,可引致神经痛症或神经性病变痛症[8]。由感受器受刺激和神经系统受损引起的疼痛是两大主要疼痛,第三类是精神性疼痛英语Psychalgia,较为罕见。

痛觉感受器引起的疼痛可细分为三类:[9]

  1. 表面躯体疼痛(或皮肤疼痛)由皮肤或身体表面组织受损而引起。由于皮肤痛觉感受器分布细密,所以其产生的痛觉明显、位置明确但短暂。小伤口和轻度烧伤引起的疼痛属此类。
  2. 深层躯体疼痛源自韧带血管肌肉,由躯体痛觉感受器感应,其分布较疏,引起隐隐作痛的感觉,位置亦不明显。扭伤、断骨和肌膜疼痛症候群属此类。
  3. 内脏疼痛源自身体的器官。内脏痛觉感受器的分布更疏,产生的痛感更强和更长时间,更能检查出引起痛觉的地方。

疼痛与疾病

疼痛是许多疾病的常见或主要症状,如脑肿瘤头痛冠心病发作时的胸痛胆石症的胆绞痛和腹痛、晚期肿瘤患者的癌性疼痛等。有些疼痛本身就是一种疾病,如带状孢疹的神经痛、三叉神经痛。疼痛不仅给患者带来痛苦,而且还对人体中枢神经、循环、呼吸、内分泌、消化和自主神经等系统造成不良影响,甚至是某些严重的、威胁生命的疾病症状。[10]

注释和参考

  1. ^ This often quoted definition was first published in 1979 by IASP in Pain journal, number 6, page 250. It is derived from a definition of pain given earlier by Harold Merskey: "An unpleasant experience that we primarily associate with tissue damage or describe in terms of tissue damage or both." Merskey, H. (1964), An Investigation of Pain in Psychological Illness, DM Thesis, Oxford.
  2. ^ See IASP Pain Terminology 互联网档案馆存档,存档日期2008-05-12.. The whole entry on the term pain itself reads like this:

    Pain. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.

  3. ^ McCaffery M. Nursing practice theories related to cognition, bodily pain, and man-environment interactions. LosAngeles: UCLA Students Store. 1968.
  4. ^ More recently, McCaffery defined pain as "whatever the experiencing person says it is, existing whenever the experiencing person says it does.” Pasero, Chris; McCaffery, Margo. Pain: clinical manual. St. Louis: Mosby. 1999. ISBN 0-8151-5609-X. .
  5. ^ National Pain Education Council 互联网档案馆存档,存档日期2008-06-13.
  6. ^ From the American Board of Medical Specialties 互联网档案馆存档,存档日期2008-05-16. website: "Pain Medicine is the medical discipline concerned with the diagnosis and treatment of the entire range of painful disorders. (...) Due to the vast scope of the field, Pain Medicine is a multidisciplinary subspecialty (...)."
  7. ^ "Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause." Source: IASP Pain Terminology 互联网档案馆存档,存档日期2008-05-12..
  8. ^ Compare definitions at IASP Pain Terminology 互联网档案馆存档,存档日期2008-05-12.: "Neurophathic pain — Pain initiated or caused by a primary lesion or dysfunction in the nervous system." and "Neurogenic pain — Pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation in the peripheral or central nervous system."
  9. ^ Pain Physiology 互联网档案馆存档,存档日期2008-04-01.
  10. ^ 王惠霞. 麻醉与疼痛. 世界图书出版广东有限公司. : 2. ISBN 978-7-5100-4566-0 (中文). 

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