Samueli Institute, Alexandria, Virginia, USA.
Pain Med. 2014 Apr;15 Suppl 1:S40-53. doi: 10.1111/pme.12411.
Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM therapies (ACT-CIM) allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management.
A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities.
Following key database searches, 146 randomized controlled trials were included in the review, 30 of which investigated movement therapies, as defined by the authors.
This article summarizes the current evidence, quality, efficacy, and safety of these modalities. Recommendations and next steps to move this field of research forward are also discussed. The entire scope of the review is detailed throughout the current Pain Medicine supplement.
慢性疼痛管理通常包括处方药物或基于提供者的行为、干预程序,但这些方法往往效果不佳,可能成本高昂,且可能伴有不良副作用。由于慢性疼痛会影响整个人(身体、思想和精神),因此以患者为中心的补充和综合医学(CIM)疗法承认患者在自身疗愈过程中的作用,有可能提供更高效、全面的慢性疼痛管理。积极的自我护理 CIM 疗法(ACT-CIM)可以更全面、以患者为中心地治疗复杂症状,促进自我管理,并且相对安全且具有成本效益。迄今为止,尚无系统评价检查用于慢性疼痛症状管理的 ACT-CIM 的全部范围。
采用 Samueli 研究所快速文献评估方法进行系统评价,严格评估 ACT-CIM 模式的研究质量,以及其治疗慢性疼痛症状的疗效和有效性的证据。还召集了一个主题专家工作组,以评估整个文献库并为这些模式的使用和实施提供建议。
在进行了主要数据库搜索后,本综述纳入了 146 项随机对照试验,其中 30 项研究了运动疗法,这是作者定义的。
本文总结了这些模式的当前证据、质量、疗效和安全性。还讨论了推进该研究领域的建议和下一步措施。整个综述的范围在当前《疼痛医学》增刊中详细介绍。