来源：《自然》
原文刊登日期：2023年3月29日
Pain is generally regarded by researchers and medical practitioners as the body’s warning system for a biomechanical problem: it is the alarm for when a finger has a cut, a joint is inflamed or a tumour is growing. Medical professionals will treat the underlying problem, and the pain is expected to recede. But what happens when the alarm doesn’t turn off? What happens when the pain doesn’t stop, long after tissues have healed? What happens when there’s pain even in the absence of tissue damage?
疼痛通常被研究人员和医生视为人体生物机制的预警系统：当手指被割伤、关节发炎或肿瘤生长时，疼痛是警报。医疗专业人员将治疗潜在的疾病，并预计疼痛就会消退。但是，当警报没有关闭时怎么办？当疼痛在组织愈合很久之后仍未停止时怎么办？即使没有组织损伤，也会感到疼痛，怎么办？
Pain itself is a medical condition. Chronic pain, generally defined as pain that lasts for more than three months, affects millions of people worldwide every day. It is likely to affect more of us in the coming decades, in line with increases in the incidence of obesity, diabetes and autoimmune diseases. All of these conditions increase a person’s likelihood of developing chronic pain.
疼痛本身就是一种疾病。慢性疼痛，通常被定义为持续三个月以上的疼痛，每天影响着全球数百万人。在未来几十年，随着肥胖、糖尿病和自身免疫性疾病发病率的增加，它可能会影响更多的人。所有这些疾病都会增加一个人患上慢性疼痛的可能性。
Chronic pain has many manifestations and numerous causes, and basic research in neuroscience and immunology has contributed much to our understanding of it. Geneticists and epidemiologists are probing the heritable and environmental factors that contribute to the risks. It is also becoming clearer that chronic pain is tied to a complex mix of neurological, immunological, psychological and social factors. Various factors and processes can drive a person’s pain and might change over time.
慢性疼痛有多种表现和众多原因，神经科学和免疫学的基础研究为我们对它的理解做出了很大贡献。遗传学家和流行病学家正在探索导致疼痛风险的遗传和环境因素。越来越清楚的是，慢性疼痛与神经、免疫、心理和社会因素的复杂混合有关。各种因素和过程都可能导致一个人的疼痛，并可能随着时间的推移而改变。
But the multifactorial nature of pain is often not recognized by the medical establishment, especially by clinicians. Medical research is starting to engage with this biopsychosocial model of pain, and therapies have been developed that can — to some extent at least — help to quieten those unrelenting alarms. But accessing the right combination of treatments, or any treatment at all in some cases, is not easy. One considerable hurdle is the lack of recognition of the value of interventions such as yoga, acupuncture and psychotherapy, in addition to medicines. In some cases, health-care policies and insurance systems are also a barrier.
但疼痛的多因素本质往往不被医疗机构，特别是临床医生所认可。医学研究已经开始着手研究疼痛的生物心理社会模型，并且已经开发出了治疗方法，至少在某种程度上可以帮助平息这些无休止的警报。但是，获得正确的治疗组合，或者在某些情况下获得任何治疗，并不容易。一个相当大的障碍是，除了药物之外，人们对瑜伽、针灸和心理治疗等干预措施的价值缺乏认识。在某些情况下，卫生保健政策和保险制度也是一个障碍。
For example, integrative care (such as that involving pain psychologists, physical therapists and spinal specialists) can sometimes be more effective in treating chronic pain than are single interventions, such as painkiller injections. However, in the United States, health-insurance plans often exclude these more-complex treatment plans. Furthermore, some US health-care providers are known to favour those interventions for which they are paid more by insurers, even if there are more effective (but less lucrative) alternatives. If a clinician is paid the same for administering a 30-minute painkiller injection as for providing a much longer course of treatment, this could be seen as incentivizing the shorter, more lucrative option. The country’s lack of both universal health coverage and mandatory paid sick leave also prevents many people from benefiting from the treatment options available to them.
例如，综合护理（如疼痛心理学家、物理治疗师和脊柱专家参与的护理）有时在治疗慢性疼痛方面比单一干预措施（如止痛药注射）更有效。然而，在美国，健康保险计划往往将这些更复杂的治疗计划排除在外。此外，众所周知，一些美国医疗保健提供商倾向于那些保险公司向它们支付更多费用的治疗方案，即使有更有效（但利润较低）的替代方案。如果临床医生用30分钟注射止痛药的报酬与提供更长疗程的报酬相同，这可以被视为激励选择更短、更有利可图的治疗方案。美国缺乏全民医疗保险和强制性带薪病假，也使许多人无法从现有的治疗方案中受益。