疼痛

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疼痛
ICD-10 R52
ICD-9 338
DiseasesDB 9503
MedlinePlus 002164
MeSH D010146

身體的疼痛指通常由身體損傷、病患或不良的外部刺激所引起的不舒服感覺。出於臨床研究的需要,國際疼痛研究協會(International Association for the Study of Pain)將疼痛定義為「由真正存在或潛在的身體組織損傷所引起的不舒服知覺和心理感覺」[1][2]

疼痛是主觀的感覺,早於1968年疼痛處理專家Margo McCaffery首次提出一個在護理學界普遍使用的定義:「一個人說感到痛,這就是痛;他說痛仍在,痛就仍在。」(原文:Pain is whatever the experiencing person says it is, existing whenever he says it does)[3][4]

身體疼痛是看醫生的主要原因;在美國,有一半看醫生的人是因為疼痛,是最普遍的原因。[5]疼痛也是大部分病患的徵狀,可根據維持時間、強度、種類(如火燒、針刺般等)、位置等來診斷。通常疼痛會自然消退,或通過簡單的止痛處理後消退,這可稱作「急性」疼痛。但有時疼痛本身已是一種病患,如慢性痛症。近年痛症引起了不同學科專家的關注,如藥理學神經生物學護理學物理治療心理學,並形成了疼痛處理Pain management)這門在麻醉學、物理治療、神經學精神科等專科之下的附屬專科[6]

用語區分[编辑]

本文的疼痛(pain)指身體的疼痛,是主觀、有意識的感覺。而痛覺Nociception)則指感受器周圍神經系統脊髓受有害刺激而引起的無意識活動[7]

分類[编辑]

痛觉感受器nociceptor)受到化學、熱力或撞擊等可損傷身體組織的刺激就可能會產生疼痛。若神經系統由病患或損傷而受損,可引致神經痛症或神經性病變neuropathy)痛症[8]。由感受器受刺激和神經系統受損引起的疼痛是兩大主要疼痛,第三類是精神性疼痛Psychalgia),較為罕見。

痛觉感受器引起的疼痛可細分為三類:[9]

  1. 表面軀體疼痛(或皮膚疼痛)由皮膚或身體表面組織受損而引起。由於皮膚痛觉感受器分布細密,所以其產生的痛覺明顯、位置明確但短暫。小傷口和輕度燒傷引起的疼痛屬此類。
  2. 深層軀體疼痛源自韌帶血管肌肉,由軀體痛觉感受器感應,其分布較疏,引起隱隱作痛的感覺,位置亦不明顯。扭傷斷骨肌膜疼痛症候群屬此類。#內臟疼痛源自身體的器官。內臟痛觉感受器的分布更疏,產生的痛感更強和更長時間,更能檢查出引起痛覺的地方。

外部連結[编辑]

註釋和參考[编辑]

  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. 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
  6. ^ From the American Board of Medical Specialties 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.
  8. ^ Compare definitions at IASP Pain Terminology: "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