临终心理的理论和研究综述

死亡是人生生老病死必经的最后历程,对临终病人心理的研究,临终护理的探索有重大意义,本文从临终病人的心理及其发展状况,以及临终心理的调适等角度出发,对国内外的临终心理研究进行回顾,并对其中的理论和研究结果做出总结性分析,并对今后研究需要注意的方向加以讨论。     

Human Dignity and the Ethics and Aesthetics of Pain and Suffering

Inasmuch as unmitigated pain and suffering areoften thought to rob human beings of theirdignity, physicians and other care providersincur a special duty to relieve pain andsuffering when they encounter it. When pain andsuffering cannot be controlled it is sometimesthought that human dignity is compromised.Death, it is sometimes argued, would bepreferred to a life without dignity.Reasoning such as this trades on certainpreconceptions of the nature of pain andsuffering, and of their relationships todignity. The purpose of this paper is to laybare these preconceptions. The duties torelieve pain and suffering are clearly mattersof moral obligation, as is the duty to respondappropriately to the dignity of other persons.However, it is argued that our understanding ofthe phenomena of pain and suffering and theirrelationships to human dignity will be expandedwhen we explore the aesthetic dimensions ofthese various concepts. On the view presentedhere the life worth living is both morally goodand aesthetically beautiful. Appropriate``suffering with' another can help to maintainand restore the dignity of the relationshipsinvolved, even as it preserves and enhances thedignity of patient and caregiver alike.     

The Social Pain Posit

Although discussion of social pain has become popular among researchers in psychology and behavioural neuroscience, the philosophical community has yet to pay it any direct attention. Social pain is characterized as the emotional reaction to the perception of the loss or devaluation of desired relationships. These are argued to comprise a pain type and are explicitly intended to include the everyday sub-types grief, jealousy, heartbreak, rejection, and hurt feelings. Social pain is accordingly posited as a nested type of pain encompassing multiple emotional sub-types. Call this the social pain posit. This article focuses on whether we should endorse the social pain posit and, in particular, whether social pain is pain. I present the four lines of evidence for the social pain posit that are currently offered in the literature and I argue that each provides only inadequate support, taken either individually or together. I close by considering the significance of the presented argument for philosophical theorizing about the nature and the moral significance of affective experiences in particular and mental taxonomizing more generally.     

老年慢性疼痛患者疼痛接受与疼痛程度的相关关系

了解老年慢性疼痛患者疼痛接受与疼痛程度,探讨两者的相关关系.采用简易慢性疼痛接受问卷（CPAQ-8）中文版、简化McGill疼痛问卷（SF-MPQ）与一般情况调查表对335例老年疼痛患者进行调查.结果纳入有效样本308例,SF-MPQ总体平均分为（50.24±23.35）分,中文版CPAQ-8总体平均得分（21.74±5.97）分.老年慢性疼痛患者的受教育程度、疼痛期、疼痛部位及疼痛点数目等差异有统计学意义（P＜0.05）.疼痛接受与疼痛程度呈负相关（P＜0.01）,即接受程度越高者,其疼痛程度越低.     

新生儿疼痛管理方法与培训现状

总结了目前新生儿疼痛管理方法与培训现状.疼痛管理方法包括非药物性止痛方法如口服蔗糖水、非营养性吸吮、襁褓包裹及袋鼠式护理等,药物镇痛如瑞芬太尼与丙泊酚用于小儿气管插管及其他;培训现状包括权威教科书上缺少关于新生儿疼痛管理知识、缺乏特异性调查问卷、缺乏专业师资及培训机构.认为在新生儿的治疗护理中医护人员要坚持科学的认识论,把握医学伦理学的要求,在日常的治疗护理中体现对新生儿的人文关怀,才能进一步提高医疗护理质量,达到医院与患者的双赢.     

Caring for Dying Children and Their Families: MFTs Working at the Gates of the Elysian Fields

The constant comparison method was used to analyze seven in-depth interviews with Marriage and Family Therapists and some of their colleagues working with dying children and their families. The findings of the study revealed that working in these settings can encourage shifts in priorities, relationships, and beliefs about life and death, and can elicit professional growth. Also, it can carry with it significant costs such as emotional exhaustion, and hypervigilance about death. Implications for practice and training are discussed. In the Greek mythology, the Elysian Fields is the place where the souls of the heroes and the virtuous dwell in the afterlife. It is the equivalent of the Christian Heaven. Portions of this paper were presented at the 65th Annual Conference of the American Association for Marriage and Family Therapy, Long Beach, CA, 2007.     

Adolescent Boys’ Use of Emo Music as Their Healing Lament

Emo music is one avenue through which God can begin or continue a process of healing found through connectedness, sharing, and understanding. God can use songs of lament to bring awareness of pain. Emo music can also offer an environment for the suffering individual to begin to think about and develop vocabulary to describe their pain. In some cases, the music can serve as a prayer of faith for the adolescent, allowing him to connect with God.     

Sex, Aggression, and Pain: Sociobiological Implicatios for Theological Anthropology

Theological anthropology can be enriched by paying attention to insights into human behavior taken from sociobiology. The capacity for reflective self-consciousness enables the human animal to respond to basic instincts and drives in unprecedented ways. Humans follow gender-specific sexual strategies, display aggressive behavior, and respond to physical pain as do other animals. Yet human beings have the intellectual ability to express these tendencies uniquely in either destructive or constructive ways. The human being, unlike any other animal, must reckon with sexual ethics, the problem of violence, and the meaning of suffering. In developing the basic concepts of theological anthropology—good creation, natural evil, fall, sin, and image of God—sociobiological research can lead to more adequate understanding of the human.     

慢性腰背痛患者和抑郁症患者的情绪、睡眠及疼痛症状

本研究对慢性腰背痛患者、抑郁症患者和对照人群的疼痛、抑郁水平、焦虑水平和睡眠质量进行测评,发现慢性腰背痛患者的抑郁、焦虑程度增高,失眠较常见;抑郁症患者的焦虑和失眠现象严重,疼痛是其常见症状。结果提示临床上对慢性疼痛患者和抑郁症患者的疼痛、情绪和睡眠问题予以评定和治疗具有重要意义。     

Weal and Woe: Suffering,Sociology, and the Emotions of Julian of Norwich

The power which narratives of mystical experience exert on our thinking derives from the central place of emotions within them. These narratives are crucial to the phenomenon of healing: not as cure, but as a means of accepting, understanding, and minimising suffering. Contemporary religious thought draws heavily on social theory but this paper shows not only that mystical emotions have escaped the attention of sociology, but also that sociology is unable to provide an adequate account of them or of their place in overcoming pain of all kinds. It does so by comparing three very different books about the emotions: Deborah Lupton's The Emotional Self (1998), Jack Barbalet's Emotions, Social Theory and Social Structure (1998), and the fourteenth century Revelations of Divine Love by Julian of Norwich. The last of these illuminates what the other two call the extra-discursive, embodied and unconscious dimensions of emotions. The first part of the paper makes a general comparison and the second turns to a range of specific emotions: shame and guilt, sorrow and depression, anger, fear, and anxiety, and the positive emotions of joy, love, and desire. This comparison helps explain how people live with chronic suffering and transcend it. It also shows that sociology, by making society itself a thing and elevating it to God-like status, cannot provide the critique of theology which was one of its original intentions, nor fully account for the healing influence of mystical phenomena.     

The Accuracy of the DSM-IV Pain Disorder and the ICD-10 Persistent Somatoform Pain Disorder in Chronic Pain Patients

Objectives. In this investigation we studied the relationships between different psychological relevant subgroups and the presence of different psychosomatic symptoms in a sample of chronic pain patients, testing the accuracy of the DSM- and ICD classification systems.Results. We found no evidence for a “pure” pain syndrome according to the DSM- and ICD systems. On the contrary, we found highly significant evidence of a mixed psychosomatic condition.Conclusion. The results suggest a broad somatoform classification, with subgroups based on personality characteristics taking a stress—coping model into account, including interpersonal attachment behaviour. An alternative model of a diagnostic approach is presented.     

慢性腹痛

慢性腹痛病史较长,性质不定。引起慢性腹痛的原因很多,除器质性疾病外,一些功能性疾病也引起,如最终找不出具体原因,则可称之为功能性腹痛综合征。诊断比较困难,也容易误诊,甚至误治,外科医生应特别慎重。误诊的思维原因包括对引起慢性腹痛的原因认识不全面,思维惰性,辩证思维不周密和思维简化等。     

The Neurobiological Underpinnings of Coping With Pain

ABSTRACT— The biopsychosocial model treats pain as resulting from a complex interaction of biological, psychological, and social factors. Individual differences in approaches to coping with pain-related symptoms are important determinants of pain-related outcomes, and are often classified under the "psychological" category within the biopsychosocial model. However, engagement in various cognitive, affective, and behavioral pain-coping strategies appears to exert biological effects, which we review here. Pain-coping activities such as catastrophizing, distracting oneself from pain sensations, or reappraisal of pain may exert effects on activity in a variety of pain-processing and pain-modulatory circuits within the brain, as well affect the functioning of neuromuscular, immune, and neuroendocrine systems. The interface between pain-related neurobiology and the use of specific pain-coping techniques represents an important avenue for future pain research.     

Pain: Biopsychosocial Mechanisms and Management

Traditionally, pain has been viewed as a sensory event warning of tissue damage or illness. This explanation fails to account for many of the experiences of people suffering from clinically painful conditions. Over the past two decades, a new biopsychosocial perspective on pain has emerged. This perspective emphasizes that pain is a dynamic process that not only is influenced by biological, psychological, and social mechanisms of pain, but also produces biological, psychological, and social changes that can affect future responses to pain. This review presents findings from recent studies of the biological, psychological, and social mechanisms of pain and discusses the implications of these findings for pain research, assessment, prevention, and treatment, as well as for health care policy.     

The Future of Psychology in Pain Management

Pain treatment facilities have proliferated in recent years and psychology has enjoyed considerable success in the clinical and research arenas of pain management. However, changes in the health care environment present significant challenges to the future of psychology in pain management. This article discusses concerns in three important areas of pain treatment that psychologists must address if they are to maintain a strong presence in this field: (1) evaluating and treating patients in the pain treatment setting, (2) evaluating and enhancing the efficacy of pain treatment, and (3) applying pain treatment services to other patient populations. With appropriate attention to these issues, psychology can continue to thrive in pain treatment settings.     

麻醉科医师在晚期癌痛治疗中的作用

1986年WHO推出的“三阶梯”癌痛镇痛用药方案目前在临床工作中存在误区。麻醉科医师必须明确在晚期癌痛治疗转变中的责任和义务:具有专业能力、保健与防病能力,消除使用阿片类药物成瘾恐惧症;团队协作能力、新技术的评估能力,实行跨学科综合姑息保健;遵循生物心理社会医学模式,对晚期癌痛患者实施人文关怀。不仅会运用药物和医疗技术手段,还需配合心理和社会方面进行全面的诊疗,更好地为患者服务。     

治疼必需知痛

疼痛是人体可感知所有伤害性刺激中最难以忍受的恶性刺激,医学范畴下的疼痛是指组织损伤的前提下产生的＂躯体的不愉快的疼感觉＂加上＂与之相匹配的痛苦情感体验＂两方面内容。长期以来我们的医疗行为＂过多关注组织损伤对疼的调控、忽视了痛苦体验的人文关怀＂制约了我们服务层次。新的生物医学模式下诊疗工作强调细化疼痛分类、躯体与心理并重,以专科诊疗思路指导临床,提高医务人员对病痛的理解、引导供需匹配式的人性医疗服务是时代发展务实之举。