慢性疼痛正逐渐受到人们的关注。除了内脏疼痛、骨关节疼痛、癌性疼痛等可观察、能触及的疼痛以外，还有一种看不见、摸不着的“疼痛”，即心因性疼痛，在诊断和治疗时需考虑在内，有时心理因素引起的疼痛是病痛缠绵的真正主谋。

Chronic pain is gradually got the attention of people.In addition to visceral pain/Joint pain/Cancerous pain can be observed/To reach the outside of pain,Still have a kind of invisible/touched"pain",Namely psychogenic pain,In the diagnosis and treatment should be taken into consideration,Sometimes the psychological factors of pain is pain touching true mastermind.

　　人到中年的张女士两年来四处求诊，直至最近才明确了疼痛的病因并经治疗好转。到底是怎样的疼痛让张女士在如此漫长的时间里备受煎熬？

The person arrives middleaged of ms. Zhang two years attending around,Until recently has been clear about the pain of the etiology and treatment of the turn for the better.How exactly is the pain to ms. Zhang in the such long periods of time is suffering?

　　最初，张女士的疼痛仅限于背部及肩部，有紧绷感伴酸痛，两三个月后酸痛转移到右膝关节，继而全身多处疼痛。到医院多次检查，结果都是“未发现异常”。一个偶然的机会在心身科找到了病因，疼痛居然与心理因素有关！经过三周的住院治疗，张女士的多处疼痛明显减轻。

first,Ms. Zhang pain is limited to back and shoulders,A tight feeling with pain,Two or three months after ache transfer to right knee,Then the whole body pain.Check to the hospital many times,The result is"No abnormalities are found".An accidental opportunity in psychosomatic families find the cause,Pain incredibly and psychological factors!After three weeks of hospitalization,Ms. Zhang the much place of pain significantly reduce.

　　原来，张女士在去年春节后由于工作变动休息在家，同时儿子远赴海外求学，空闲多了，生活的重心反而无处安置，与家人的矛盾逐渐显现。张女士的疼痛在这种情况下悄然出现。在进入心身科病房之前，她在多家综合性医院的疼痛科、麻醉科、骨科、康复科反复就诊，虽然发现一些慢性病变，但是无法解释痛因，也缺乏有效的办法缓解。直到接受了心身科的多维治疗方法，她的疼痛才逐渐减轻。

The original,Ms. Zhang in after the Spring Festival last year because of job change rest at home,At the same time son far go to study abroad,More leisure,Life is the center of gravity for instead,And family contradiction appears gradually.Ms. Zhang pain in this case appear sadly.In the psychosomatic wards before,She in several comprehensive hospital pain clinic/Anesthesiology department/orthopaedic/Rehabilitation department to see a doctor again and again,Although found some chronic lesions,But cannot explain because of the pain,And the lack of effective way to alleviate.To accept the psychosomatic family multidimensional treatment,Her pain to gradually ease.

　　疼痛的发生与许多因素有关，包括神经递质变化、性格基础以及环境因素等，而张女士的治疗就是针对这几个维度展开，主要包括药物治疗和心理治疗。

Pain and many factors,Including neurotransmitter change/Character basis and environmental factors,And ms. Zhang treatment is aimed at this several dimensions expansion,Mainly include drug therapy and psychological therapy.

　　首先张女士遵照医生的指示服用了抗抑郁药物。起初张女士还不能理解，自己明明没有抑郁症，为什么还要服用抗抑郁药呢？经医生解释，她才明白，原来慢性疼痛的产生与体内的某些神经递质如去甲肾上腺素(NE)和5-羟色胺(5-HT)浓度降低有关，目前临床上常用来治疗慢性疼痛的抗抑郁药有选择性5-羟色胺再摄取抑制剂(SSRI)和5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRI)，它们可通过抑制突触间隙5-HT和NE的再摄取，从而提高突触间隙5-HT和NE的浓度，导致疼痛减轻并缓解。这个突触间隙如同一个仓库，既进货又出货，如果设一警卫阻止货物搬出，则仓库中的货物就会明显增多，货物就类似于神经递质，而这个警卫就是抗抑郁药。

First ms. Zhang follow the doctor's instructions taking antidepressant medication.At first, ms. Zhang also can't understand,Yourselves no depression,Why take antidepressants?The doctor explained,She didn't understand,For the generation of chronic pain in the body and some neurotransmitters such as norepinephrine(NE)And serotonin(5 - HT)Concentration to reduce the,At present the clinical commonly used to treat chronic pain antidepressants have selective serotonin reuptake inhibitors(SSRI)And serotonin and norepinephrine reuptake inhibitor(SNRI),They can inhibit the synaptic cleft 5 - HT and NE of the reuptake,So as to improve the synaptic cleft 5 - HT and NE concentration,Lead to a reduction in pain and ease.The synaptic cleft as a warehouse,Both purchase and delivery,If you set a guard to prevent goods move out,The warehouse the goods will be increased significantly,Cargo is similar to the neurotransmitter,The guard is antidepressants.

　　心身科医生还给张女士进行了认知心理治疗。张女士自幼被父母视为掌上明珠，稍有不适，其母亲就极为紧张，长大后张女士对自己的身体不适也极为关注，比如每次疼痛时就出现自动式思想，如“我快要不行了”，因此反复求医，极度恐惧，严重影响了正常生活，生活质量明显降低。认知心理治疗最重要的是，使病人一步步认识到自己的认知歪曲如过分夸大及任意推断，并促使其产生认知性的改变。

Psychosomatic family doctor back to ms. Zhang on the cognitive psychological treatment.Ms. Zhang from parents as the apple of the eye,Slight discomfort,His mother is extremely nervous,Ms. Zhang grew up to his body is also Paramount concern,Such as pain every time when they appear to be automatic type thought,if"I'm not",So the doctor away repeatedly,Extreme fear,Seriously affected the normal life,Life quality significantly.Cognitive therapy is the most important,Make the patient step by step to realize their own cognitive distortion such as exaggerated and arbitrary inference,And urge its produce cognitive change.

　　心身科的集体心理治疗是多维治疗方法的组成之一，也是张女士需要住院医治的原由。焦虑、烦恼、躯体不适感包括疼痛是人类普遍存在的心身现象，坦然地面对和接受，“顺应自然、为所当为”，在集体氛围中，充分调动集体成员间的互助性、暗示性和互动性而增进疗效。

Psychosomatic section of collective psychological therapy is multidimensional treatment method is one of the composition,Is ms. Zhang need to be hospitalized heal of reason.anxiety/trouble/Physical discomfort including pain is the human common psychosomatic phenomenon,Have to face and accept,"Conform to the nature/For what is",In the collective atmosphere,Give full play to the members of the collective the coadjutant sex between/Suggestibility and interactivity and improve curative effect.

　　针对张女士的背痛和肩痛主要以紧绷感为主，通过运用相关仪器设备，张女士学会了一套音乐放松技术，跟着音乐的节奏和语音提示，自己可以有意识地自我放松包括头部、颈部、背部、四肢等处的肌肉，这样出院以后就可以在疼痛发生时自我调节，自我放松。此外，张女士还每天参加生物反馈、脑功能反射等治疗，都有助于缓解疼痛，改善睡眠。

According to ms. Zhang back and shoulder pain mainly tight feeling is given priority to,Through the application of related equipment,Ms. Zhang learned a set of music to relax technology,Follow the rhythm of the music and the voice prompt,You can consciously relax including head/neck/back/Limbs of the place such as muscle,So after discharge in pain occurs the self-adjustment,relax.In addition,Ms. Zhang and every day to participate in biological feedback/Brain function treatment such as reflection,All help ease the pain,Improve sleep.

　　通过介绍张女士的治疗经过，我们知道，疼痛并非都是看得见、摸得着的，有些人的慢性疼痛反复检查仍难以找到病因的时候，一定要考虑心理社会因素，也许病根就在其中。（骆艳丽 陆峥）

Through the introduction of ms. Zhang treatment,We know that,Pain is not are visible/tangible,Some people's chronic pain repeated examination is still difficult to find the causes of time,Must consider the psychological and social factors,May know the disease is in them.(LuoYanLi LiuZheng)