Anderson Karen O, Cohen Marlene Z, Mendoza Tito R, Guo Hong, Harle Margaret T, Cleeland Charles S
Department of Symptom Research, Division of Internal Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2006 Jul 1;107(1):207-14. doi: 10.1002/cncr.21964.
Few studies have evaluated cognitive-behavioral interventions as an adjunct treatment for chronic cancer-related pain. A randomized clinical trial was performed evaluating the efficacy of 3 brief cognitive-behavioral techniques: relaxation, distraction, and positive mood interventions.
Fifty-seven patients with chronic cancer-related pain taking opioid medications were randomly assigned to either the relaxation, distraction, positive mood, or waiting-list control group. The patients in the 3 intervention groups received audiotapes of the cognitive-behavioral technique and were asked to practice regularly at home. The tapes were supplemented with written instructions and follow-up telephone calls.
Patients in the relaxation and distraction groups reported significantly reduced pain intensity immediately after listening to the tapes. The pain reduction was not maintained, however. At the 2-week follow-up assessment, no significant differences in pain intensity or interference were found among the treatment groups. The groups also did not differ with regard to secondary outcome measures assessing quality of life, mood, self-efficacy, and other symptoms. The results of qualitative interviews indicated that patients often had difficulty focusing on the audiotapes and preferred their own methods of pain reduction.
Brief relaxation and distraction audiotape interventions produced immediate pain reductions but not longer-term pain relief. Additional research with a more individualized intervention is needed to evaluate cognitive-behavioral interventions for cancer pain control.
很少有研究评估认知行为干预作为慢性癌症相关疼痛辅助治疗的效果。进行了一项随机临床试验，以评估三种简短认知行为技术的疗效：放松、分散注意力和积极情绪干预。
57名正在服用阿片类药物的慢性癌症相关疼痛患者被随机分配到放松组、分散注意力组、积极情绪组或等待名单对照组。三个干预组的患者收到了认知行为技术的录音带，并被要求在家中定期练习。录音带配有书面说明和后续电话随访。
放松组和分散注意力组的患者在听完录音带后立即报告疼痛强度显著降低。然而，疼痛减轻并未持续。在2周的随访评估中，各治疗组在疼痛强度或干扰方面未发现显著差异。在评估生活质量、情绪、自我效能和其他症状的次要结局指标方面，各组也没有差异。定性访谈结果表明，患者通常难以专注于录音带，更喜欢自己的减轻疼痛方法。
简短的放松和分散注意力录音带干预可立即减轻疼痛，但不能长期缓解疼痛。需要进行更多个性化干预的研究，以评估认知行为干预对癌症疼痛控制的效果。
