通过情感自我意识减轻纤维肌痛的持续性疼痛：一项随机对照试验。
Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial.
机构信息
Department of Physical Medicine & Rehabilitation, Kaiser-Permanente Northwest, Portland, OR, USA.
出版信息
J Gen Intern Med. 2010 Oct;25(10):1064-70. doi: 10.1007/s11606-010-1418-6. Epub 2010 Jun 8.
BACKGROUND AND OBJECTIVE
Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia.
PARTICIPANTS AND METHODS
Forty-five women with fibromyalgia were randomized to a manualized ASA intervention (n = 24) or wait-list control (n = 21). The intervention began with a one-time physician consultation, followed by 3 weekly, 2-h group sessions based upon a mind-body model of pain. Sessions focused on structured written emotional disclosure and emotional awareness exercises. Outcomes in both conditions were measured by a blinded assessor at baseline, post-intervention, and 6-month follow-up.
MEASURES
The primary outcome was pain severity (Brief Pain Inventory); secondary outcomes included tender-point threshold and physical function (SF-36 Physical Component Summary). Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥ 30% and ≥ 50% pain reduction at 6 months.
RESULTS
Adjusting for baseline scores, the intervention group had significantly lower pain severity (p < 0.001), higher self-reported physical function (p < 0.001), and higher tender-point threshold (p = 0.02) at 6 months compared to the control group. From baseline to 6 months, 45.8% of the ASA intervention group had ≥ 30% reduction in pain severity, compared to none of the controls (p < 0.001).
CONCLUSIONS
The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control. This study suggests the value of interventions targeting emotional processes in fibromyalgia, although further studies should evaluate the efficacy of this intervention relative to active controls.
背景与目的
情感及其调控在疼痛感知、疼痛维持和疼痛缓解中发挥作用。本随机对照试验评估了一种创新的情感自我意识（ASA）干预措施，旨在减轻纤维肌痛患者的疼痛并改善其功能。
参与者和方法
45 名纤维肌痛女性患者随机分为手册化 ASA 干预组（n = 24）或候补名单对照组（n = 21）。干预始于一次医生咨询，随后进行 3 次每周、2 小时的小组会议，基于疼痛的身心模型。会议重点是结构化的书面情感披露和情感意识练习。在基线、干预后和 6 个月随访时，由盲法评估员测量两组的结局。
测量
主要结局是疼痛严重程度（简明疼痛量表）；次要结局包括压痛阈值和身体功能（SF-36 身体成分综合评分）。意向治疗分析使用协方差分析比较了两组在结局上的差异，并比较了两组在 6 个月时达到≥30%和≥50%疼痛缓解的患者比例。
结果
调整基线评分后，干预组的疼痛严重程度显著降低（p < 0.001），自我报告的身体功能更高（p < 0.001），压痛阈值更高（p = 0.02），与对照组相比，6 个月时差异均有统计学意义。从基线到 6 个月，ASA 干预组中有 45.8%的患者疼痛严重程度降低≥30%，而对照组中无一例患者（p < 0.001）。
结论
与候补名单对照组相比，情感自我意识干预至少在 6 个月内改善了纤维肌痛女性的疼痛、压痛和自我报告的身体功能。本研究表明，针对纤维肌痛患者情绪过程的干预措施具有价值，尽管还需要进一步研究来评估该干预措施相对于活性对照的疗效。
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