慢性疼痛与抑郁的心身医学整合观

生物医疗观对慢性疼痛患者的诊疗作用较差。慢性疼痛常因为心理应激、个性、行为和疾病状况而复杂化,增加了患者诊疗的难度。患者常因情感症状、生活压力,而失去信心,陷入无助地痛苦选择冲突中。应用一种系统的跨学科方法重建和保持医生的共情和患者的积极心理,采用疾病状态、生活经历、个性特征和行为模式的四种心身整合观点,综合评估抑郁和慢性疼痛患者。设计综合诊疗方案评定的痛苦作用,在方案制定的过程中认识到这四个观点彼此不同,相互补充,全面阐释影响患者痛苦的生物、心理和社会的多种原因。心身整合观点为设计合理的治疗方案提供了方法,提高了医生成功治疗慢性疼痛患者的可行性。     

Psychological mechanisms underlying the relationship between commercial physical activity app use and physical activity engagement

PurposePrevious studies have indicated a relationship between the use of commercial physical activity apps (e.g., Fitbit, Strava) and physical activity engagement. The use of social components of such apps, in particular app-specific communities (connecting with other app users) and existing social networking platforms (e.g., Facebook) have the potential to enhance physical activity. This study aimed to explore the psychological mechanisms underlying the relationship between the use of commercial physical activity apps (and their social components) and physical activity engagement.MethodAn online cross-sectional survey assessed physical activity, use of commercial physical activity apps (and their associated social components), and psychological constructs (social support, self-efficacy, motivation, trait competitiveness, trait social comparison).Results1274 adults aged 18–83 years (M_age = 34.1 ± 13.5 years, 87.6% female) participated. App use was positively associated with physical activity engagement. The relationship between app use and physical activity was fully mediated by social support, self-efficacy, intrinsic motivation and identified regulation. Trait competitiveness, but not trait social comparison, moderated the relationship between app use and physical activity. Most features (e.g., sharing posts, providing or receiving encouragement) of the social components of apps were positively associated with psychological constructs linked to engagement in physical activity. Mediation pathways linking features of existing social networking platforms with physical activity were found. Specifically, sharing posts was linked to higher engagement in physical activity via positive associations with self-efficacy, and receiving encouragement with linked to higher engagement in physical activity via positive associations with both self-efficacy and identified regulation. In addition, engagement in comparisons was associated with lower self-efficacy and higher external regulation, and in turn, lower physical activity.ConclusionsThe relationship between the use of commercial physical activity apps and physical activity is underpinned by social support, self-efficacy and autonomous motivations. The findings highlight the importance of trait competitiveness, which should be taken into consideration when leveraging physical activity apps. Overall, the present study demonstrated that commercial physical activity apps (and their social components) hold great potential to increase physical activity engagement given their associations with psychological constructs strongly linked with physical activity.     

Cognitive Behavioral Therapy for Postamputation Chronic Pain: A Case Report

Limb amputation has a significant impact on an individual, not only physically but emotionally. Consequences of both traumatic and atraumatic amputations are vast and can result in functional disability, impaired emotional functioning, and changes in overall quality of life. These consequences may be further complicated by the development of chronic pain. Traditional management of postamputation chronic pain often involves invasive procedures and pharmacotherapy. While research notes behavioral interventions, such as cognitive-behavioral therapy (CBT) as a viable treatment alternative for chronic pain, there is no literature supporting CBT for postamputation chronic pain. In this case report, we present a 63-year-old male lower limb amputee complicated with chronic pain who experienced pain reduction and improved quality of life following manualized treatment with CBT for chronic pain. Treatment took place over 12 sessions with fidelity (93%) being measured throughout to ensure accurate utilization of the treatment manual. As part of the treatment manual, self-report measures (Pain Rating Scale, Pain Catastrophizing Scale, Pain Outcomes Questionnaire, and subjective units of distress) were used throughout to track patient progress. All measures showed improvement with the biggest gains being seen in pain ratings and pain catastrophizing.     

对新冠病毒肺炎危重症患者引入缓和医疗的伦理论证

新型冠状病毒肺炎尚无治疗特效药和疫苗。在继续加强防控的同时,把有限的资源优先放在探索对重症和危重症患者的支持性治疗,积极建立和完善对重症、危重症患者及其家属的缓和医疗等方面,有利于患者群体利益最大化,经得起伦理辩护。缓和医疗有助于改善患者预后,降低住院病死率,有效缓解患者濒死痛苦;对医患双方而言,如果死亡已无可避免,帮助临终者走得平安、少些痛苦,是医学对患者最后的人文关怀。     

Memory of pain and affect associated with migraine and non-migraine headaches

The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.     

疼痛恐惧相关的注意偏向及其矫正

疼痛恐惧是影响和维持慢性痛的重要因素。不同材料和被试类型情况下, 疼痛恐惧均主要作用于个体对疼痛相关信息的早期注意加工阶段, 表现为注意警觉模式。该注意模式使个体将注意维持在疼痛上, 从而干扰了对非疼信息的注意能力。矫正疼痛恐惧相关注意偏向可以改善疼痛体验。未来研究应采用更具生态效度的任务测量疼痛恐惧相关的注意偏向及其神经基础, 进一步考察矫正疼痛恐惧相关注意偏向能否改善慢痛患者的忧郁和功能丧失等问题。     

疼痛恐惧的形成、泛化与消退

疼痛恐惧源于把疼痛等同于伤害的灾难化信念及对疼痛的负性解释, 它在慢性疼痛和能力丧失的发生和发展过程中起着重要作用。疼痛恐惧可以通过联合学习和观察学习等方式获得, 并且在具有相似特征的刺激中存在泛化现象。通过教育干预和等级暴露疗法等可以成功消退疼痛恐惧, 在消退过程中要控制安全信息等因素的不良影响。在疼痛恐惧的获得与消退中, 主要有杏仁核, 脑岛和前扣带皮层等脑区参与。未来的研究可以集中在深入探讨疼痛恐惧形成中的泛化及消退后的恢复、再巩固等现象, 加强其临床上的应用, 并综合心理、生物和认知神经科学, 研究疼痛恐惧的获得、泛化与消退的深层机制。     

Female physical attractiveness in Britain and Malaysia: a cross-cultural study

Two purported cues to perceived female physical attractiveness are body mass index (BMI) and body shape as measured by the waist-to-hip ratio (WHR). This study examined the relative contribution of both cues in several culturally socio-economically distinct populations. Six hundred and eighty-two participants from Britain and Malaysia were asked to rate a set of images of real women with known BMI and WHR. The results showed that BMI is the primary determinant of female physical attractiveness, whereas WHR failed to emerge as a significant predictor. The results also showed that there were significant differences in preferences for physical attractiveness along a gradient of socio-economic development, with urban participants preferring images of women with significantly lower BMIs than their rural counterparts. The findings are discussed in terms of evolutionary psychological explanations of mate selection, and sociocultural theory, which emphasises the learning of preferences for body sizes in social and cultural contexts.     

子宫内膜异位症引起的盆腔疼痛的诊断和治疗

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,且发病率呈逐年上升趋势,盆腔疼痛是它常见的症状之一,其发病机制尚未明确,易复发,成为妇科研究的热点和难点。随着对EMT引起盆腔疼痛的发病机理的不断认识,其诊治也相应得到完善和发展。本文从哲学的角度以认识和实践等观点对EMT引起盆腔疼痛的诊断和治疗进展进行综述,以助于临床诊治。     

多模式镇痛在幻肢痛预防中的临床研究

为探讨多模式镇痛预防截肢后幻肢痛的临床效果。选择50例下肢截肢患者,随机分为2组,试验组（Ⅰ组）和对照组（Ⅱ组）,观察患者疼痛评分,患者自控镇痛按压次数,使用其他镇痛药物的情况,记录所有的不良反应及幻肢痛发生率。结果显示,镇痛评分,Ⅱ组高于Ⅰ组（P〈0．01）;PCA按压次数,Ⅱ组多于Ⅰ组（P〈0．01）;不良反应发生率Ⅱ组高于Ⅰ组（P〈0．01）;Ⅱ组幻肢痛发生率明显高于Ⅰ组（P〈0．01）。采取多模式镇痛预防幻肢痛是安全有效的。