Dobscha Steven K, Corson Kathryn, Leibowitz Ruth Q, Sullivan Mark D, Gerrity Martha S
Columbia Center for Study of Chronic, Comorbid Physical and Mental Disorders, Portland VA Medical Center, Portland, Oregon 97207, USA.
Pain Med. 2008 Nov;9(8):1050-64. doi: 10.1111/j.1526-4637.2008.00457.x. Epub 2008 Jun 18.
This article describes the rationale, design, and baseline findings from an ongoing study of collaborative care for chronic musculoskeletal pain and comorbid depression.
Cluster randomized clinical trial.
Forty-two clinicians and 401 patients from five Veterans Affairs primary care clinics.
The intervention was based on the chronic care model, and included patient and provider activation and education, patient assessment, outcomes monitoring, and feedback to providers over 12 months. The intervention team consisted of a full-time psychologist care manager and a part-time physician internist. Approaches included goal setting emphasizing function, patient activation and educating about fear avoidance, and care management.
Main outcomes are Roland-Morris Disability Questionnaire (RMDQ) score, depression severity (Patient Health Questionnaire-9), and pain severity (Chronic Pain Grade Severity subscale) at 6 and 12 months.
Fifteen percent of primary care patients mailed a study advertisement letter requested screening for the study. The mean age of enrolled patients was 62. Back and neck or joint pain diagnoses were present in 67% and 65% of patients, respectively. Mean pain duration was 15 years, and mean RMDQ score (range 0-24) was 14.7 (standard deviation = 4.4). Sixty-five percent of patients were receiving disability. Eighteen percent of patients met criteria for major depression, 17% for posttraumatic stress disorder, and 9% for alcohol misuse. Thirty-nine percent of patients felt strongly that experiencing pain was a sign of damage, and 60% reported strong avoidance of painful activities.
These baseline data support the rationale to develop a multifaceted approach to treat chronic pain in primary care that includes detection and treatment of psychiatric comorbidity.
本文描述了一项正在进行的针对慢性肌肉骨骼疼痛合并抑郁症的协作护理研究的基本原理、设计和基线结果。
整群随机临床试验。
来自五个退伍军人事务初级保健诊所的42名临床医生和401名患者。
干预基于慢性病护理模式，包括患者和提供者的激活与教育、患者评估、结果监测以及在12个月内向提供者反馈。干预团队由一名全职心理医生护理经理和一名兼职内科医生组成。方法包括强调功能的目标设定、患者激活以及关于恐惧回避的教育和护理管理。
主要结果是6个月和12个月时的罗兰-莫里斯残疾问卷（RMDQ）评分、抑郁严重程度（患者健康问卷-9）和疼痛严重程度（慢性疼痛分级严重程度子量表）。
15%的初级保健患者邮寄了研究广告信，要求进行研究筛查。入选患者的平均年龄为62岁。分别有67%和65%的患者被诊断为背部和颈部或关节疼痛。平均疼痛持续时间为15年，平均RMDQ评分（范围0 - 24）为14.7（标准差 = 4.4）。65%的患者正在领取残疾津贴。18%的患者符合重度抑郁症标准，17%符合创伤后应激障碍标准，9%符合酒精滥用标准。39%的患者强烈认为经历疼痛是损伤的迹象，60%的患者报告强烈避免进行疼痛活动。
这些基线数据支持在初级保健中制定多方面方法来治疗慢性疼痛的基本原理，该方法包括检测和治疗精神疾病合并症。
