Leuven Centre for Algology and Pain Management, University Hospitals of Leuven, Leuven, Belgium.
Curr Med Res Opin. 2011 Aug;27(8):1595-601. doi: 10.1185/03007995.2011.595779. Epub 2011 Jun 22.
There is a need for effective brief interventions in chronic pain patients, and the identification of mechanisms of change.
In the present study, we tested the effectiveness of MPEP (Multidisciplinary Pain Education Program), a very brief, four-session cognitive-behaviorally based psycho-educational intervention for chronic pain using a pre-and post-test design. In addition, pre- to post-treatment change scores were calculated to investigate factors associated with change in pain. Participants of the study were 53 patients with chronic non-cancer pain. Primary outcome measures were (1) pain severity, (2) health perception, and (3) severity of depression. Secondary outcome measures included factors that have been implicated in the maintenance of chronic pain and that might be associated with worse treatment outcome: (1) catastrophizing, (2) kinesiophobia, and (3) action-proneness.
Findings provided preliminary evidence for the effectiveness of MPEP in that patients showed significant and clinically meaningful improvements in pain symptoms (F = 24.503, p < 0.001, d = 0.59) and action-proneness (F = 178.504, p < 0.001, d = 1.95), and small improvements in health perception (F = 7.116, p < 0.05, d = 0.30). Furthermore, results showed that changes in catastrophizing (β = -0.455, p = 0.001) and severity of depression (β = -0.300, p < 0.05) were independently and significantly associated with changes in pain. However, changes in health perception, kinesiophobia, and action-proneness were not significantly associated with changes in pain (β = 0.203, ns; β = 0.003, ns; and β = 0.154, ns, respectively). Importantly, duration of chronic pain was not related to treatment outcome (β = 0.070, ns).
Overall, this study provides preliminary evidence for the effectiveness of MPEP and possible mechanisms through which MPEP is effective. Yet, further research is needed to investigate the efficacy of MPEP.
需要为慢性疼痛患者提供有效的简短干预措施，并确定其变化机制。
在本研究中，我们采用前后测试设计，测试了一种非常简短的、四节认知行为为基础的心理教育干预方法 MPEP（多学科疼痛教育计划）的有效性。此外，还计算了治疗前后的变化分数，以调查与疼痛变化相关的因素。该研究的参与者为 53 名患有慢性非癌性疼痛的患者。主要的结果测量指标包括：（1）疼痛严重程度；（2）健康感知；（3）抑郁严重程度。次要结果测量指标包括：（1）灾难化；（2）运动恐惧症；（3）行动倾向。这些因素与慢性疼痛的维持有关，并且可能与较差的治疗结果相关。
研究结果初步证明了 MPEP 的有效性，因为患者的疼痛症状（F=24.503，p<0.001，d=0.59）和行动倾向（F=178.504，p<0.001，d=1.95）均有显著且具有临床意义的改善，并且健康感知（F=7.116，p<0.05，d=0.30）也有较小的改善。此外，结果表明，灾难化（β=-0.455，p=0.001）和抑郁严重程度（β=-0.300，p<0.05）的变化与疼痛的变化独立且显著相关。然而，健康感知、运动恐惧症和行动倾向的变化与疼痛的变化无显著相关性（β=0.203，ns；β=0.003，ns；β=0.154，ns）。重要的是，慢性疼痛的持续时间与治疗结果无关（β=0.070，ns）。
总体而言，本研究初步证明了 MPEP 的有效性和 MPEP 起作用的可能机制。然而，需要进一步的研究来调查 MPEP 的疗效。
