Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, PO Box 85238, 3508 AE Utrecht, The Netherlands Adelante Zorggroep, PO Box 88, 6430 AB Hoensbroek, The Netherlands Rehabilitation Center De Hoogstraat, PO Box 85238, 3508 AE Utrecht, The Netherlands Rehabilitation Center Het Roessingh, PO Box 310, 7500 AH Enschede, The Netherlands Rijndam Rehabilitation Center, PO Box 23181, 3001 KD Rotterdam, The Netherlands.
Pain. 2012 Jan;153(1):120-128. doi: 10.1016/j.pain.2011.09.029. Epub 2011 Nov 17.
Many people with spinal cord injury (SCI) rate chronic neuropathic pain as one of the most difficult problems to manage. The aim of the CONECSI (COping with NEuropathiC Spinal cord Injury pain) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI. The intervention consisted of educational, cognitive, and behavioral elements. A total of 61 people were randomized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers. Primary outcomes were pain intensity and pain-related disability (Chronic Pain Grade questionnaire), and secondary outcomes were mood (Hospital Anxiety and Depression Scale), participation in activities (Utrecht Activities List), and life satisfaction (Life Satisfaction Questionnaire). Measurements were performed at baseline, and at 3, and 6 months follow-up. The primary statistical technique was random coefficient analysis. The analyses showed significant changes over time on both primary (t1-t2), and 2 out of 4 secondary outcomes (both t1-t2 and t1-t3). Significant intervention effects (Time*Group interactions) were found for anxiety and participation in activities, but not for the primary outcomes. Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group: decrease of pain intensity, pain-related disability, anxiety, and increase of participation in activities. This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain.
许多脊髓损伤(SCI)患者将慢性神经性疼痛评为最难治疗的问题之一。CONECSI(应对神经性脊髓损伤疼痛)试验的目的是评估针对慢性神经性 SCI 疼痛患者的多学科认知行为治疗方案。该干预措施包括教育、认知和行为元素。共有 61 名参与者在荷兰的 4 家康复中心被随机分配到干预组或等待名单对照组。主要结果是疼痛强度和与疼痛相关的残疾(慢性疼痛等级问卷),次要结果是情绪(医院焦虑和抑郁量表)、活动参与度(乌得勒支活动清单)和生活满意度(生活满意度问卷)。在基线、3 个月和 6 个月随访时进行测量。主要统计技术是随机系数分析。分析表明,在两个主要结果(t1-t2)和 4 个次要结果中的 2 个(t1-t2 和 t1-t3)上均出现显著的随时间变化。在焦虑和活动参与方面发现了显著的干预效果(时间*组相互作用),但主要结果没有发现。随后的配对 t 检验显示,干预组出现了对照组未见的显著变化:疼痛强度、与疼痛相关的残疾、焦虑和活动参与度均有所降低。本研究表明,多学科认知行为方案可能对慢性神经性 SCI 疼痛患者有益。