以严重中下腹疼为主要表现的躯体形式疼痛障碍诊治探讨

Diagnosis and treatment of pain disorder of middle inferior belly

目的探讨以长期严重中下腹痛为主要表现的躯体疼痛障碍的临床特征和诊治。方法本组以中下腹疼痛为主要表现的躯体形式疼痛障碍病例16例,经医院汉密顿抑郁量表(HAMD-24)检查评分大于30分,经CT、生化等相关检查排除躯体疾病后给予抗抑郁药物联合心理疏导治疗。结果经半月治疗后16例患者疼痛明显减轻,坚持治疗3个月后10例疼痛完全缓解,6例明显减轻,焦虑抑郁症状基本消失。患者在抗抑郁治疗后第1周,HAMD-24评分的减分率均在25%以上,提示患者的抑郁情绪有改善,第4周HAMD-24评分的减分率均在50%以上,显示患者抑郁状态明显好转,在12周HAMD-24评分达到8分以下,患者HAMD-24评分呈现逐渐减低的趋势。结论采用汉密顿抑郁量表(HAMD-24)检测对疾病的诊断有比较大的帮助,对疗效评估及病情变化观察也有较大价值。躯体形式疼痛障碍虽对镇痛药、镇静药无效,但抗抑郁药物联合心理疏导可以获得意外治疗效果。

Objective To investigate the diagnosis and treatment of pain disorder of middle inferior belly. Methods From 2000 to 2013, we enrolled 16 cases presenting as chronic severe middle and lower abdominal pain, whose Hamilton Depression Scale （HAMD-24） examination scores were greater than 30. CT scan together with serum biochemical examination excluded physical disorder after anti-depressant treatment combined with psychological counseling. Results After half month＇s treatment, the pain of 16 patients ameliorated significantly and even disappeared. The symptoms of 6 patients obviously improved and, particularly, the anxiety and depression symptoms almost disappeared. After one week＇s anti-depression treatment, HAMED-24 scores of these patients reduced by over 25%, indicating improvement of depression symptoms. In 4 weeks, HAMD-24 scores reduced over 50%, indicating that the depression symptoms of these pa- tients remarkably improved. In 12 weeks, HAMD-24 scores were under 8. These data demonstrated that HAMD-24 scores of these patients gradually decreased in a time-dependent manner after treatment with anti-depressants combined with psychological counseling. Conclusion There is value for Hamilton Rating Scale for Depression （HAMD-24） to diagnose persistent soma to form pain disorder presenting as chronic severe middle and lower abdominal pain. In addition, HAMD-24 scoring system is also helpful to evaluate therapeutic efficacy and monitor disease progression. Although both analgesics and sedatives seem invalid for this disease, antidepressant drugs combined with psychological counseling might lead to unexpected therapeutic effects.