McDonald Deborah Dillon, Walsh Stephen, Vergara Cunegundo, Gifford Timothy
University of Connecticut, Storrs, Connecticut.
University of Connecticut, Storrs, Connecticut.
Pain Manag Nurs. 2013 Dec;14(4):200-209. doi: 10.1016/j.pmn.2011.03.004. Epub 2011 May 31.
There is a need to enhance patient and practitioner pain communications. A pain communication plus virtual pain coach intervention was tested in the primary care setting for the effect on communication of osteoarthritis pain information by older adults aged ≥60 years, on practitioners' pain management changes, and on older adults' reduced pain and depressive symptoms 1 month later. A randomized controlled pilot study design was used. Twenty-three older adults with osteoarthritis pain were randomly assigned to the pain communication plus virtual pain coach group or the pain communication-only group. Pain communication consisted of a video of important osteoarthritis pain information. The coach consisted of practicing out loud with a virtual pain coach via laptop computer. Pain and depressive symptoms were measured with, respectively, the Brief Pain Inventory Short Form and the Beck Depression Inventory II before intervention and 1 month later. Immediately after the intervention, older adults had their primary care visits, which were audiotaped, transcribed, and content analyzed for older adults' communicated pain information and practitioners' pain management changes. Older adults in the pain communication plus virtual pain coach group described significantly more pain source information and were prescribed significantly more osteoarthritis pain treatments than older adults in the pain communication-only group. A nonsignificant trend in pain intensity and depressive symptoms reduction resulted for older adults in the pain communication plus virtual pain coach group 1 month later. The virtual pain coach presents a possible strategy for increasing pain management discussions between practitioners and older adults with persistent pain.
有必要加强患者与医生之间关于疼痛的沟通。在初级保健环境中测试了一种疼痛沟通加虚拟疼痛指导干预措施，以观察其对60岁及以上老年人骨关节炎疼痛信息沟通、医生疼痛管理变化以及1个月后老年人疼痛减轻和抑郁症状缓解的影响。采用了随机对照试验研究设计。23名患有骨关节炎疼痛的老年人被随机分配到疼痛沟通加虚拟疼痛指导组或仅疼痛沟通组。疼痛沟通包括一段关于重要骨关节炎疼痛信息的视频。指导包括通过笔记本电脑与虚拟疼痛指导进行大声练习。在干预前和1个月后，分别使用简明疼痛问卷简表和贝克抑郁量表第二版测量疼痛和抑郁症状。干预后，老年人进行了初级保健就诊，就诊过程进行了录音、转录，并对老年人传达的疼痛信息和医生的疼痛管理变化进行了内容分析。与仅疼痛沟通组的老年人相比，疼痛沟通加虚拟疼痛指导组的老年人描述了更多的疼痛源信息，并且被开出了更多的骨关节炎疼痛治疗药物。1个月后，疼痛沟通加虚拟疼痛指导组的老年人在疼痛强度和抑郁症状减轻方面呈现出不显著的趋势。虚拟疼痛指导为增加医生与患有持续性疼痛的老年人之间的疼痛管理讨论提供了一种可能的策略。
