How Young Children Construe Pain Experienced by Self and Others: A Case of Naive Theory

We investigated young children's construal of pain in relation to (a) the self, (b) other humans, and (c) animals, plants, and objects, to elucidate children's cognitive understanding of this complex, abstract, subjective concept. We interviewed 17 Kindergarten students using a variety of non-painful stimuli and procedures to prompt discussion of pain's causes, consequences, intensity, contagion, and treatment. Findings suggest that young children use naive theory to describe pain that only partly agree with canonic knowledge and were cognizance of the need to treat pain and cope with it. Awareness of children's construal of pain may promote caregivers' and teachers' ability to effectively treat pain-related situations and contribute to the design of a relevant curriculum for enhancing their knowledge about pain.     

疼痛与心理学的关系及其心理治疗

传统观点认为,疼痛感觉是人体神经系统对机体遭受损伤或外界刺激而出现的反应,但很多研究表明,疼痛感觉与刺激的强度并不是对等的关系,还有很多因素影响个体的痛觉,比如心理学的因素。文章重点介绍疼痛产生的生理机制及其特点,疼痛与心理学的关系并据此提出心理治疗及护理,从而减轻患者的疼痛感,改善患者的生活质量。     

人类疼痛实验模型方法及评价研究进展

疼痛是各种疾病最常见的症状,是当今困扰人类健康最严重的问题之一。目前临床上应用的镇痛药种类有限,且大多具有镇痛效果不强和／或成瘾、耐受等明确的副作用,致使大量的疼痛患者得不到有效的治疗。因而急需开发新型不成瘾和副作用小的镇痛药。由于难以在人体对疼痛进行深入的机制和药效研究,往往通过建立疼痛的动物模型来筛选和鉴定镇痛候选药物。很多研究表明,根据动物疼痛模型的镇痛效果,很难预测其在人类身上的镇痛作用,导致临床研究常常出现令人困惑和模糊混乱的评价结果。新兴的人类疼痛实验模型,有望成为镇痛新药研发中联系动物实验和临床试验的有机桥梁,用于评价候选镇痛新药的作用机制和疗效,可为临床试验提供更加科学的设计方案,增加临床试验的成功率。该文拟对在健康志愿者身上进行的人类疼痛实验模型的研究进展进行综述,以期为加快新型镇痛药物的研发进程提供借鉴和参考。     

泛素-蛋白酶体系统在疼痛发生中的机制研究新进展

泛素-蛋白酶体系统是细胞内蛋白质降解的重要途径之一,它通过降解细胞内各通路的抑制因子和（或）激活因子发挥上调和下调作用,是维持细胞内许多生理功能的重要系统。近年来,有文献报道泛素一蛋白酶体系统由于参与抑制疼痛的细胞因子和蛋白质降解,从而成为神经性疼痛的重要发病因素。实验已经证实蛋白酶体抑制剂能够抑制神经性疼痛和痛觉过敏,从而进一步肯定了泛素-蛋白酶体系统在神经性疼痛发生机制中的作用。     

Do abused young children feel less pain?

The objective of this study was to investigate whether acute pain in abused children was under recognized by doctors and nurses compared to children evaluated for accidental injuries. We hypothesize that an abused child’s reaction to physical pain could be an additional symptom of this challenging diagnosis. For the observational prospective case control study in an emergency department, children were eligible when: younger than six years old, the reported trauma occurred within the previous seven days, the trauma comprised a bone injury or burn, and the child was able to express his or her pain. The case group comprised children for whom the medical team reported their abuse suspicions and supporting information to a court, and whose cases of abuse were subsequently confirmed. The control group consisted of children with a plausible cause for their injury and no obvious signs of abuse. The children were matched according to their age and type of trauma. The pain was assessed by doctors and nurses before analgesic administration using a certified pain scale.Among the 78 included children, pain was significantly less recognized in the abused children vs. the controls (relative risk = 0.63; 95% CI: 0.402–0.986; p = 0.04). We observed a discrepancy between the nurses’ and doctors’ scores for the pain assessments (Kappa coefficient = 0.59, 95% CI: 0.40–0.77). Our results demonstrate that pain expression in abused children is under recognized by medical staff. They also suggest that abused children may have reduced pain expression after a traumatic event. Paying particular attention to the pain of abused children may also optimize the analgesic treatment.     

Sexual, physical, verbal/emotional abuse and unexplained chest pain

Objectives

Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress.

Methods

Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures.

Results

Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01–31.80, P = 0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96–30.83, P = .05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90–27.61), P = 0.08.

Conclusions

A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression.     

住院癌症患者的疼痛控制状况及疼痛对生活质量影响的调查

目的：调查住院肿瘤患者的疼痛控制情况,以及癌痛对肿瘤患者生活质量的影响,为癌痛护理实施提供依据。方法：对376例住院肿瘤患者进行了调查,调查采用癌痛患者疼痛调查表,其中包括疼痛部位调查,24 h疼痛的轻重程度调查,使用止疼药物的调查,24 h受疼痛影响的程度。结果：本组患者目前的癌痛评分（NRS评分）平均为（4.10±2.48）分;有过疼痛的患者为371例（98.67%）,既往使用口服药物止痛208例（89.27%）;使用过非药物止痛疗法的患者有189例（50.27%）。生活质量在24 h受疼痛影响的程度,影响最大的是日常生活（6.51±2.43）分,影响最小的是睡眠（3.46±2.62）分。结论：疼痛对癌症患者的生活质量产生影响,住院患者癌痛控制效果有待加强。     

毽球运动与膝关节疼痛治疗研究

毽球运动具有负荷小、易坚持的特点,适合锻炼膝关节周围肌肉、韧带.以骨性关节炎、膝关节创伤后造成的慢性疼痛患者为研究对象,让受试者进行长期毽球运动锻炼,结果观察到膝关节疼痛患者在运动后,疼痛症状减轻,膝关节轻松有力,达到了治疗关节疼痛的效果.     

缺血修饰白蛋白在急性胸痛患者鉴别诊断中的价值

目的探讨血清缺血修饰白蛋白（IMA）在急性胸痛患者鉴别诊断中的价值。方法通过检测163例由于急性胸痛来我院就诊的患者血清中IMA水平,根据患者最终诊断结果,从而判断IMA在急性胸痛患者中的鉴别诊断价值。结果研究显示在163例患者中,心源性胸痛患者为102例,IMA值为（98．37±19．12）。非心源性胸痛为61例,IMA值为（32．54±12．11）。结论IMA在急性胸痛患者的检测中可以有效地鉴别心源性胸痛和非心源性胸痛,对于减少心源性胸痛的漏诊起到了显著的作用。     

《暮光之城》:真爱源自禁锢

爱情,人类精神中一种最深沉的冲动,但是震撼人心的深挚爱情,往往来自外界的禁锢与束缚。贝拉与爱德华之间凄美动人的爱情故事是贯穿《暮光之城》的主线,禁欲色彩在这段人鬼之恋中扮演着至关重要的角色,来自外在与内在的禁锢和束缚给这段禁忌爱恋造成了巨大的痛苦。然而,这种痛苦却恰恰成就了爱情的恒久与伟大,将两人炙热而绝望,隐忍而深情的爱恋发挥到了极致。     

The relationship between childhood emotional abuse and chronic pain among people who inject drugs in Vancouver,Canada

BackgroundPeople who inject drugs (PWID) often contend with chronic pain as a result of illness and trauma, and such pain is known to have significant impacts on mental health, quality of life, and substance use behaviours. Although PWID are also known to have high rates of childhood trauma, little is known about how childhood emotional abuse may be associated with chronic pain in this population.ObjectiveWe undertook this study to explore emotional abuse and chronic pain among PWID.Participants and settingThis study comprised a total of 1459 participants in Vancouver, Canada between June 2014 and November 2016.MethodsWe employed multivariable generalized estimating equations with data derived from two prospective cohort studies of community-recruited PWID to examine the relationship between childhood emotional abuse and chronic pain in the past six months.ResultsAmong eligible participants, 591 (40.5%) reported childhood emotional abuse, and 760 (52.1%) reported chronic pain in the previous six months. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with chronic pain (adjusted odds ratio: 1.25; 95% confidence interval: 1.01–1.53) after adjustment for a range of socio-demographic and drug use confounders.ConclusionsOur findings suggest that childhood emotional abuse may have lasting relationships with chronic pain among PWID, potentially through established physiological and psychological mechanisms. Current chronic pain treatment may benefit from the evaluation of life course vulnerabilities that may be amenable to earlier interventions. Further, increased availability of effective trauma-informed chronic pain treatment is needed among this vulnerable population.     

癌症晚期患者疼痛的护理体会

目的 探讨癌痛护理在缓解晚期癌症疼痛患者中的作用.方法 采用语言评价量表（VRS）对患者疼痛进行评分,观察73例癌痛患者在采取护理措施前后的疼痛程度,进行统计学分析,评价疼痛护理的止痛效果.结果 癌痛护理前Ⅰ °疼痛患者4例（5.5％）;Ⅱ°疼痛64例（87.7％）;Ⅲ°疼痛5例6.8％）.在采取了有效的护理措施后完全缓解至无痛的60例（82.2％）,部分缓解为10例（14％）,无效3例（4％）.结论 护理人员对晚期癌症疼痛患者采取了综合性护理措施,使疼痛得到有效控制,能主动地配合治疗,生活质量明显改善.     

运动疼痛的心理社会因素分析

以文献资料法阐述心理社会因素对运动疼痛的形成所产生的影响,为进一步探索运动疼痛的预防和治疗的方法提供理论依据.     

替尔伸冤 泪尽血消——20世纪20年代鲁迅诗中的恨与痛

鲁迅20世纪20年代的诗歌创作蕴含着无尽的恨与痛。天性中的恨让鲁迅在对国家的大爱里升发出对革命的希望;流血牺牲的代价与人生的苦痛相联,让鲁迅坚定了继续革命的信念;讽刺的语言和复仇的思想又对恨与痛的融合进行补充,共同奠定了这一时期鲁迅诗歌创作的情感基调。     

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.     

性格导致的痛苦——对阮籍为人为诗的分析

阮籍为人为诗都让人感觉到一种悲抑的痛苦情绪,这种痛苦源自于他的性格。阮籍性格内向,做人谨慎小心,内在情感从不轻易外露,长期压抑自己的情绪而内心痛苦不堪。他的怪诞行为、旨意不明的诗歌正是这种由性格导致的痛苦的表现。     

No Pain No Gain? Reflections on Decolonisation and Higher Education in South Africa

Abstract

Calls for the decolonisation of higher education in South Africa have been punctuated by comments on black pain. This is not surprising if it is acknowledged that violence inordinately marks so much of South African life. What is rarely discussed though is the idea that pain has also come to be fetishised. Pain, for example, is valued as a pedagogical means. While invoking notions of the decolonisation of education that cohere with humanisation, the authors critically reflect on the ways in which pain remains a dehumanising feature of higher education in South Africa. In doing so, they hope to start a discussion around issues seldom addressed more than in deeply felt sentiments that are rarely clarified and defined in terms of their importance for the transformation and decolonisation of higher education.     

舒芬太尼皮下自控镇痛用于晚期癌痛

探讨舒芬太尼皮下自控镇痛(Patient-controlled subcutaneous analgesia,PCSA)用于晚期癌痛的可行性。选择晚期癌痛病例60例,随机分为3组,每组20例:Ⅰ组为口服吗啡组,Ⅱ组为芬太尼贴剂组,Ⅲ组为舒芬太尼PCSA组。分析治疗一周内视觉模拟评分(VAS),便秘、恶心呕吐、爆发性疼痛次数,病人家属满意度等五项数值差异。结果显示,三组在同样剂量递加的基础上,Ⅲ组VAS评分低于Ⅰ、Ⅱ组(P<0.05)。结果表明,舒芬太尼PCSA在晚期癌症镇痛效果好于口服吗啡和芬太尼贴剂,便秘、恶心呕吐、爆发性疼痛等不良事件发生率低,家属满意度高,值得临床推广。     

个体的痛苦与群体的冷漠--契诃夫的《苦恼》与鲁迅的《祝福》比较

通过对《苦恼》与《祝福》的比较，从个体的痛苦与群体的冷漠的角度，对《祝福》的思想意蕴作了新的分析。