Rains Jeanetta C, Lipchik Gay L, Penzien Donald B
Center for Sleep Evaluation, Elliot Hospital, Manchester, NH 03103, USA.
Headache. 2006 Oct;46(9):1387-94. doi: 10.1111/j.1526-4610.2006.00581.x.
Noncompliance or nonadherence with medical regimens represents a major challenge to the practice of medicine including the treatment of headache. Indeed, medication use patterns are particularly relevant to headache because of the potential for headache therapies to induce medication-overuse headache. Previous research has demonstrated that adherence to long-term medication therapy for various chronic illnesses averages only about 50%. The rate of adherence among headache patients has been found to be similarly poor. Misuse or overuse of symptomatic medication has been demonstrated to contribute to treatment failure, and one-fourth to one-half of patients are noncompliant with prophylactic headache medications and at least 40% nonadherent with appointment-keeping. Adherence declines with more frequent and complex dosing regimens, side effects, and costs, and is subject to a wide range of psychosocial influences. Subjective reports of adherence are likely not only to overestimate but also to be discordant with more objective measurements. As the first of 2 articles, this paper describes the problem of noncompliance in medical practice and reviews literature addressing compliance specific to headache management. A companion paper (Behavioral Facilitation of Medical Treatment for Headache--Part II: Theoretical Models and Behavioral Strategies for Improving Adherence) summarizes social learning models proposed to characterize the multiple determinants of adherence and guide behavioral adherence-enhancing interventions, and then presents cognitive and behavioral strategies that may facilitate treatment adherence with headache patients.
不遵守或不坚持医疗方案是医学实践（包括头痛治疗）面临的一项重大挑战。事实上，药物使用模式与头痛特别相关，因为头痛疗法有可能引发药物过度使用性头痛。先前的研究表明，各种慢性病长期药物治疗的依从率平均仅约为50%。研究发现头痛患者的依从率同样很低。有证据表明，对症药物的滥用或过度使用会导致治疗失败，四分之一到二分之一的患者不遵守预防性头痛药物治疗，至少40%的患者不遵守预约安排。随着给药方案更频繁、更复杂，出现副作用以及费用增加，依从性会下降，并且依从性还受到广泛的社会心理影响。关于依从性的主观报告不仅可能高估依从性，而且可能与更客观的测量结果不一致。作为两篇文章中的第一篇，本文描述了医学实践中的不依从问题，并回顾了针对头痛管理依从性的文献。另一篇配套论文（《头痛医疗的行为促进——第二部分：改善依从性的理论模型和行为策略》）总结了为描述依从性的多个决定因素并指导增强行为依从性的干预措施而提出的社会学习模型，然后介绍了可能促进头痛患者治疗依从性的认知和行为策略。
