Kwekkeboom Kristine L, Wanta Britt, Bumpus Molly
University of Wisconsin-Madison School of Nursing, Madison, Wisconsin 53792, USA.
J Pain Symptom Manage. 2008 Dec;36(6):604-15. doi: 10.1016/j.jpainsymman.2007.12.011. Epub 2008 May 27.
Clinicians in acute care settings are often called upon to manage cancer pain unrelieved by medications. Cognitive-behavioral strategies, such as relaxation and imagery, are recommended for cancer pain management; however, there appear to be individual differences in their effects. This pilot study examined variation in pain outcomes achieved with progressive muscle relaxation (PMR) and analgesic imagery interventions among hospitalized patients with cancer pain, and assessed the influence of four individual difference variables (cognitive ability, outcome expectancy, previous experience, and concurrent symptoms) on pain relief achieved with each intervention. A crossover design was used in which 40 hospitalized cancer patients received two trials of PMR, two trials of analgesic imagery, and two trials of a control condition. In comparing means between treatment and control conditions, both PMR and analgesic imagery produced greater improvements in pain intensity, pain-related distress, and perceived control over pain than the control condition. However, individual responder analysis revealed that only half of the participants achieved a clinically meaningful improvement in pain with each intervention. Patients who achieved a meaningful improvement in pain with analgesic imagery reported greater imaging ability, more positive outcome expectancy, and fewer concurrent symptoms than those who did not achieve a meaningful reduction in pain. Similar relationships were not significant for the PMR intervention. Investigators should continue efforts to identify factors that moderate the effects of cognitive-behavioral pain coping strategies so that clinicians can identify the most beneficial treatments for individual patients.
急症护理环境中的临床医生经常需要处理药物无法缓解的癌症疼痛。推荐采用认知行为策略，如放松和想象，来管理癌症疼痛；然而，这些策略的效果似乎存在个体差异。这项试点研究调查了住院癌症疼痛患者通过渐进性肌肉松弛（PMR）和镇痛想象干预所实现的疼痛结果的差异，并评估了四个个体差异变量（认知能力、结果预期、既往经验和并发症状）对每种干预所实现的疼痛缓解的影响。采用交叉设计，40名住院癌症患者接受了两次PMR试验、两次镇痛想象试验和两次对照试验。在比较治疗组和对照组的均值时，PMR和镇痛想象在疼痛强度、疼痛相关困扰以及对疼痛的感知控制方面都比对照组有更大改善。然而，个体反应者分析显示，每种干预只有一半的参与者在疼痛方面实现了具有临床意义的改善。与未实现疼痛显著减轻的患者相比，通过镇痛想象实现疼痛有意义改善的患者报告成像能力更强、结果预期更积极且并发症状更少。对于PMR干预，类似关系并不显著。研究人员应继续努力确定调节认知行为疼痛应对策略效果的因素，以便临床医生能够为个体患者确定最有益的治疗方法。
