Heapy Alicia A, Higgins Diana M, Cervone Dana, Wandner Laura, Fenton Brenda T, Kerns Robert D
*VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center for Innovation, West Haven, CT †Yale School of Medicine, New Haven, CT ‡Boston University School of Medicine §VA Boston Healthcare System, Boston, MA.
Clin J Pain. 2015 Jun;31(6):470-92. doi: 10.1097/AJP.0000000000000185.
The use of technology to provide chronic pain self-management interventions has increased in the recent years. Individual studies have primarily focused on a single technology-assisted modality and direct comparisons of different technology-assisted modalities are rare. Thus, little is known about the relative strengths and weaknesses of each technology-assisted modality.
This article is a systematic review of technology-assisted self-management interventions for chronic nonheadache, noncancer pain in adults. We examined 3 treatment modalities: telephone, interactive voice response, and Internet. Electronic searches of OVID MEDLINE, OVID PsychINFO, and the Cochrane Database of Systematic Reviews were conducted. Forty-four articles including 9890 participants were reviewed.
Across modalities, the existing evidence suggests that technology-assisted psychological interventions are efficacious for improving self-management of chronic pain in adults. All modalities have been shown to provide benefit and no clearly superior modality has emerged. The primary gaps in the literature are lack of in-person comparison groups, lack of direct comparison among technology-assisted modalities, and heterogeneity of methods and interventions that limit comparability across studies and modalities.
Future trials should focus on direct comparisons of technology-assisted interventions with in-person treatment and head to head comparisons of different technology-assisted modalities. Additional areas of focus include quantifying the cost of technology-assisted interventions, examining the effect of treatment "dose" on outcomes, and establishing guidelines for developing treatments for the technology-assisted environment.
近年来，利用技术提供慢性疼痛自我管理干预措施的情况有所增加。个别研究主要集中在单一的技术辅助模式上，而对不同技术辅助模式的直接比较很少。因此，对于每种技术辅助模式的相对优缺点知之甚少。
本文是对针对成人慢性非头痛、非癌性疼痛的技术辅助自我管理干预措施的系统评价。我们研究了三种治疗模式：电话、交互式语音应答和互联网。对OVID MEDLINE、OVID PsychINFO和Cochrane系统评价数据库进行了电子检索。共审查了44篇文章，涉及9890名参与者。
在所有模式中，现有证据表明技术辅助心理干预对改善成人慢性疼痛的自我管理有效。所有模式都已显示出益处，且尚未出现明显更优的模式。文献中的主要差距在于缺乏面对面的对照组、技术辅助模式之间缺乏直接比较，以及方法和干预措施的异质性限制了不同研究和模式之间的可比性。
未来的试验应侧重于技术辅助干预与面对面治疗的直接比较，以及不同技术辅助模式的直接比较。其他重点领域包括量化技术辅助干预的成本、研究治疗“剂量”对结果的影响，以及制定技术辅助环境下治疗开发的指南。
