Morone Natalia E, Greco Carol M
Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Pain Med. 2007 May-Jun;8(4):359-75. doi: 10.1111/j.1526-4637.2007.00312.x.
We conducted a structured review of eight mind-body interventions for older adults with chronic nonmalignant pain.
To evaluate the feasibility, safety, and evidence for pain reduction in older adults with chronic nonmalignant pain in the following mind-body therapies: biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga.
Relevant studies in the MEDLINE, PsycINFO, AMED, and CINAHL databases were located. A manual search of references from retrieved articles was also conducted. Of 381 articles retrieved through search strategies, 20 trials that included older adults with chronic pain were reviewed.
Fourteen articles included participants aged 50 years and above, while only two of these focused specifically on persons aged >or=65 years. An additional six articles included persons aged >or=50 years. Fourteen articles were controlled trials. There is some support for the efficacy of progressive muscle relaxation plus guided imagery for osteoarthritis pain. There is limited support for meditation and tai chi for improving function or coping in older adults with low back pain or osteoarthritis. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Several studies included older adults, but did not analyze benefits by age. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies.
The eight mind-body interventions reviewed are feasible in an older population. They are likely safe, but many of the therapies included modifications tailored for older adults. There is not yet sufficient evidence to conclude that these eight mind-body interventions reduce chronic nonmalignant pain in older adults. Further research should focus on larger, clinical trials of mind-body interventions to answer this question.
我们对针对患有慢性非恶性疼痛的老年人的八种身心干预措施进行了结构化综述。
评估以下身心疗法对患有慢性非恶性疼痛的老年人减轻疼痛的可行性、安全性及证据：生物反馈疗法、渐进性肌肉松弛、冥想、引导式意象、催眠、太极拳、气功和瑜伽。
检索了MEDLINE、PsycINFO、AMED和CINAHL数据库中的相关研究。还对手检所检索文章的参考文献进行了检索。通过检索策略检索到381篇文章，其中20项纳入患有慢性疼痛老年人的试验被纳入综述。
14篇文章纳入了50岁及以上的参与者，其中只有2篇专门针对65岁及以上的人群。另外6篇文章纳入了50岁及以上的人群。14篇文章为对照试验。有一些证据支持渐进性肌肉松弛加引导式意象对骨关节炎疼痛的疗效。对于冥想和太极拳改善患有腰痛或骨关节炎的老年人的功能或应对能力，仅有有限的证据支持。在一项按年龄组分层的非对照生物反馈试验中，干预后老年人和年轻人的疼痛均显著减轻。几项研究纳入了老年人，但未按年龄分析益处。在这些研究中，太极拳、瑜伽、催眠和渐进性肌肉松弛与疼痛减轻显著相关。
所综述的八种身心干预措施在老年人群中是可行的。它们可能是安全的，但许多疗法包括了为老年人量身定制的调整。尚无足够证据得出这八种身心干预措施能减轻老年人慢性非恶性疼痛的结论。进一步的研究应聚焦于规模更大的身心干预临床试验以回答这一问题。
