Lewandowski Wendy, Jacobson Ann
College of Nursing, Kent State University, Kent, Ohio.
College of Nursing, Kent State University, Kent, Ohio.
Pain Manag Nurs. 2013 Dec;14(4):368-378. doi: 10.1016/j.pmn.2011.08.001. Epub 2012 Jan 13.
Chronic noncancer pain (CNCP) is a common and complex disorder associated with declines in physical health and functional status, emotional well-being, and quality of life. To best address the complexity of this condition, research and clinical practice for CNCP should be guided by a framework incorporating both biologic and psychologic factors. This article presents a biobehavioral model of chronic pain that hypothesizes mechanisms related to the effectiveness of a complementary therapy, guided imagery (GI), for this population. Using the research-to-model/theory strategy, we mapped findings from published reports of interdisciplinary research into physiologic and psychologic aspects of the nature and mechanisms of pain, as well as the use of GI for pain, to build the model of GI's effects on pain, pain disability, and depression. In the model, these outcomes of GI for persons experiencing CNCP are mediated by psychologic (pain self-efficacy and pain beliefs) and physiologic (immune-mediated analgesia and sickness response) variables. A biobehavioral approach to nursing phenomena will advance understanding of health and health-related issues and has the potential to improve outcomes through delineation of mechanisms underlying relationships between psychologic and biologic factors. Increased consumer use of complementary therapies to treat pain, the current cost-driven health care system, and the mandate for evidence-based practice support the need to validate the efficacy of such therapies. This empirically derived model provides a framework for practice and research for nurses and other health care providers to promote health, function, and well-being in persons with CNCP.
慢性非癌性疼痛（CNCP）是一种常见且复杂的病症，与身体健康、功能状态、情绪健康及生活质量下降相关。为了更好地应对这种病症的复杂性，CNCP的研究和临床实践应以一个整合生物和心理因素的框架为指导。本文提出了一种慢性疼痛的生物行为模型，该模型假设了一种辅助疗法——引导式意象（GI）对这一人群有效性的相关机制。我们采用从研究到模型/理论的策略，将已发表的跨学科研究报告中的发现，映射到疼痛本质和机制的生理及心理方面，以及GI用于疼痛治疗的情况，以构建GI对疼痛、疼痛残疾和抑郁影响的模型。在该模型中，GI对经历CNCP的人的这些结果是由心理（疼痛自我效能感和疼痛信念）和生理（免疫介导的镇痛和疾病反应）变量介导的。一种针对护理现象的生物行为方法将增进对健康及与健康相关问题的理解，并有可能通过阐明心理和生物因素之间关系的潜在机制来改善结果。消费者越来越多地使用辅助疗法来治疗疼痛、当前以成本为驱动的医疗保健系统以及循证实践的要求，都支持了验证此类疗法有效性的必要性。这个基于实证得出的模型为护士和其他医疗保健提供者在促进CNCP患者的健康、功能和幸福方面的实践和研究提供了一个框架。
