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纤维肌痛的心理治疗:荟萃分析。

Psychological treatments for fibromyalgia: a meta-analysis.

机构信息

Department of Psychology, Boston University, Boston, MA, USA University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.

出版信息

Pain. 2010 Nov;151(2):280-295. doi: 10.1016/j.pain.2010.06.011. Epub 2010 Aug 19.

Abstract

The aims of the present analysis were to investigate the short- and long-term efficacies and treatment moderators of psychological interventions for fibromyalgia. A literature search using PubMed, PsychINFO, the Cochrane Library, and manual searches identified 23 eligible studies including 30 psychological treatment conditions and 1396 patients. Meta-analytic integration resulted in a significant but small effect size for short-term pain reduction (Hedges's g=0.37, 95% confidence interval (CI): 0.27-0.48) and a small-to-medium effect size for long-term pain reduction over an average follow-up phase of 7.4 months (Hedges's g=0.47, 95% CI: 0.3-0.65) for any psychological intervention. Psychological treatments also proved effective in reducing sleep problems (Hedges's g=0.46, 95% CI: 0.28-0.64), depression (Hedges's g=0.33, 95% CI: 0.20-0.45), functional status (Hedges's g=0.42, 95% CI: 0.25-0.58), and catastrophizing (Hedges's g=0.33, 95% CI: 0.17-0.49). These effects remained stable at follow-up. Moderator analyses revealed cognitive-behavioral treatment to be significantly better than other psychological treatments in short-term pain reduction (Hedges's g=0.60, 95% CI: 0.46-0.76). Higher treatment dose was associated with better outcome. Publication-bias analyses demonstrated that the effect sizes were robust. The results suggest that the effects of psychological treatments for fibromyalgia are relatively small but robust and comparable to those reported for other pain and drug treatments used for this disorder. Cognitive-behavioral therapy was associated with the greatest effect sizes.

摘要

本分析的目的是研究心理干预治疗纤维肌痛的短期和长期疗效以及治疗调节因素。通过使用 PubMed、PsychINFO、Cochrane 图书馆和手动搜索进行文献检索,确定了 23 项符合条件的研究,其中包括 30 种心理治疗条件和 1396 名患者。荟萃分析结果显示,短期疼痛减轻的效果显著但较小(Hedges's g=0.37,95%置信区间(CI):0.27-0.48),在平均 7.4 个月的随访期内,长期疼痛减轻的效果为小到中等(Hedges's g=0.47,95%CI:0.3-0.65),任何心理干预均可减轻疼痛。心理治疗还被证明可以有效减轻睡眠问题(Hedges's g=0.46,95%CI:0.28-0.64)、抑郁(Hedges's g=0.33,95%CI:0.20-0.45)、功能状态(Hedges's g=0.42,95%CI:0.25-0.58)和灾难化(Hedges's g=0.33,95%CI:0.17-0.49)。这些效果在随访时保持稳定。调节分析显示,在短期疼痛减轻方面,认知行为治疗明显优于其他心理治疗(Hedges's g=0.60,95%CI:0.46-0.76)。较高的治疗剂量与较好的疗效相关。发表偏倚分析表明,效应大小是稳健的。结果表明,心理治疗纤维肌痛的效果相对较小,但稳健且可与其他用于治疗该疾病的疼痛和药物治疗的报告相媲美。认知行为疗法与最大的效果大小相关。

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