Wells-Federman Carol, Arnstein Paul, Caudill Margaret
Graduate School of Health Studies, Simmons College, Boston, MA, USA.
Pain Manag Nurs. 2002 Dec;3(4):131-40. doi: 10.1053/jpmn.2002.127178.
Nurses routinely use a variety of nonpharmacologic and patient education interventions designed to reduce pain and promote independence. Research on group programs that combine these nursing strategies in a systematic approach provides evidence that chronic pain patients can realize an enhanced confidence in their ability to manage pain (improved self-efficacy) in addition to reductions in pain, emotional distress, and disability. The purpose of this study was to investigate the effect of participating in a nurse-led cognitive-behavioral treatment (CBT) pain management program on self-efficacy, pain intensity, pain-related disability, and depressive symptoms among patients with chronic pain. Pre- and postprogram data from 154 participants were examined to identify changes in pain intensity, self-efficacy, disability, and depressive symptoms. Mean differences, effect sizes, and 95% confidence intervals were computed for the study variables and paired t-tests were done to determine if changes were significant. Z-scores were then calculated. Pearson product moment correlations were examined to test the association between changes in self-efficacy and changes in the other variables of interest. Patients in this study reported significant improvements in all scores postprogram. Self-efficacy, pain-intensity, pain-related disability, and symptoms of depression can be changed through participation in a nurse-led outpatient CBT program. In concert with results from other research on CBT pain programs this study provides further evidence that reduction in suffering and improved sense of well-being is possible even for people who have experienced pain for many years.
护士经常使用各种非药物和患者教育干预措施,旨在减轻疼痛并促进患者的独立性。对以系统方法结合这些护理策略的团体项目的研究表明,慢性疼痛患者除了疼痛减轻、情绪困扰缓解和残疾程度降低外,还能对自己管理疼痛的能力增强信心(自我效能感提高)。本研究的目的是调查参与由护士主导的认知行为疗法(CBT)疼痛管理项目对慢性疼痛患者的自我效能感、疼痛强度、疼痛相关残疾和抑郁症状的影响。对154名参与者项目前后的数据进行了检查,以确定疼痛强度、自我效能感、残疾和抑郁症状的变化。计算了研究变量的平均差异、效应量和95%置信区间,并进行了配对t检验以确定变化是否显著。然后计算Z分数。检验了皮尔逊积差相关性,以测试自我效能感变化与其他相关变量变化之间的关联。本研究中的患者报告称项目后所有分数均有显著改善。通过参与由护士主导的门诊CBT项目,自我效能感、疼痛强度、疼痛相关残疾和抑郁症状都可以得到改变。与其他关于CBT疼痛项目的研究结果一致,本研究进一步证明,即使是长期遭受疼痛折磨的人,也有可能减轻痛苦并改善幸福感。