疼痛生理学教育可改善纤维肌痛患者的健康状况和内源性疼痛抑制：一项双盲随机对照试验。

Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial.

机构信息

*Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel ‡Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels †Department of Health Care Sciences, Division of Musculoskeletal Physiotherapy, Artesis University College Antwerp, Antwerp ∥Private Practice for Internal Medicine, Gent/Aalst, Belgium §Nursing and Health Care, School of Medicine, University of Glasgow, Glasgow, UK.

出版信息

Clin J Pain. 2013 Oct;29(10):873-82. doi: 10.1097/AJP.0b013e31827c7a7d.

DOI:10.1097/AJP.0b013e31827c7a7d

PMID:23370076

Abstract

OBJECTIVES

There is evidence that education on pain physiology can have positive effects on pain, disability, and catastrophization in patients with chronic musculoskeletal pain disorders. A double-blind randomized controlled trial (RCT) was performed to examine whether intensive pain physiology education is also effective in fibromyalgia (FM) patients, and whether it is able to influence the impaired endogenous pain inhibition of these patients.

METHODS

Thirty FM patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education). The primary outcome was the efficacy of the pain inhibitory mechanisms, which was evaluated by spatially accumulating thermal nociceptive stimuli. Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status. Assessments were performed at baseline, 2 weeks, and 3 months follow-up. Repeated measures ANOVAS were used to reveal possible therapy effects and effect sizes were calculated.

RESULTS

After the intervention the experimental group had improved knowledge of pain neurophysiology (P<0.001). Patients from this group worried less about their pain in the short term (P=0.004). Long-term improvements in physical functioning (P=0.046), vitality (P=0.047), mental health (P<0.001), and general health perceptions (P<0.001) were observed. In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition (P=0.041) compared with the control group.

DISCUSSION

These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

摘要

目的

有证据表明，疼痛生理学教育对慢性肌肉骨骼疼痛障碍患者的疼痛、残疾和灾难化认知可能产生积极影响。本研究进行了一项双盲随机对照试验（RCT），以检验强化疼痛生理学教育是否对纤维肌痛（FM）患者也有效，以及是否能够影响这些患者受损的内源性疼痛抑制。

方法

30 名 FM 患者被随机分配到实验组（接受疼痛生理学教育）或对照组（接受 paced self-management education）。主要结局是疼痛抑制机制的疗效，通过空间累加热痛觉刺激来评估。次要结局指标包括压痛阈值测量和评估疼痛认知、行为和健康状况的问卷。评估在基线、2 周和 3 个月随访时进行。采用重复测量方差分析揭示可能的治疗效果，并计算效应量。

结果

干预后实验组对疼痛神经生理学的知识有了显著提高（P<0.001）。该组患者在短期内对疼痛的担忧减少（P=0.004）。长期来看，患者的身体机能（P=0.046）、活力（P=0.047）、心理健康（P<0.001）和一般健康感知（P<0.001）都得到了改善。此外，与对照组相比，干预组报告的疼痛评分较低，内源性疼痛抑制得到改善（P=0.041）。