Johnson Jill R, Crespin Daniel J, Griffin Kristen H, Finch Michael D, Dusek Jeffery A
Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF).
J Natl Cancer Inst Monogr. 2014 Nov;2014(50):330-7. doi: 10.1093/jncimonographs/lgu030.
Few studies have investigated the effectiveness of integrative medicine (IM) therapies on pain and anxiety among oncology inpatients.
Retrospective data obtained from electronic medical records identified patients with an oncology International Classification of Diseases-9 code who were admitted to a large Midwestern hospital between July 1, 2009 and December 31, 2012. Outcomes were change in patient-reported pain and anxiety, rated before and after individual IM treatment sessions, using a numeric scale (0-10).
Of 10948 hospital admissions over the study period, 1833 (17%) included IM therapy. Older patients had reduced odds of receiving any IM therapy (odds ratio [OR]: 0.97, 95% confidence interval [95% CI] = 0.96 to 0.98) and females had 63% (OR: 1.63, 95% CI = 1.38 to 1.92) higher odds of receiving any IM therapy compared with males. Moderate (OR: 1.97, 95% CI = 1.61 to 2.41), major (OR: 3.54, 95% CI = 2.88 to 4.35), and extreme (OR: 5.96, 95% CI = 4.71 to 7.56) illness severity were significantly associated with higher odds of receiving IM therapy compared with admissions of minor illness severity. After receiving IM therapy, patients averaged a 46.9% (95% CI = 45.1% to 48.6%, P <.001) reduction in pain and a 56.1% (95% CI = 54.3% to 58.0%, P <.001) reduction in anxiety. Bodywork and traditional Chinese Medicine therapies were most effective for reducing pain, while no significant differences among therapies for reducing anxiety were observed.
IM services to oncology inpatients resulted in substantial decreases in pain and anxiety. Observational studies using electronic medical records provide unique information about real-world utilization of IM. Future studies are warranted and should explore potential synergy of opioid analgesics and IM therapy for pain control.
很少有研究调查综合医学（IM）疗法对肿瘤住院患者疼痛和焦虑的有效性。
从电子病历中获取的回顾性数据确定了2009年7月1日至2012年12月31日期间入住一家大型中西部医院且患有肿瘤国际疾病分类-9编码的患者。结局指标是患者报告的疼痛和焦虑的变化，在每次IM治疗前后使用数字量表（0-10）进行评分。
在研究期间的10948例住院患者中，1833例（17%）接受了IM治疗。老年患者接受任何IM治疗的几率较低（优势比[OR]：0.97，95%置信区间[95%CI]=0.96至0.98），女性接受任何IM治疗的几率比男性高63%（OR：1.63，95%CI=1.38至1.92）。与轻度疾病严重程度的住院患者相比，中度（OR：1.97，95%CI=1.61至2.41）、重度（OR：3.54，95%CI=2.88至4.35）和极重度（OR：5.96，95%CI=4.71至7.56）疾病严重程度与接受IM治疗的几率显著相关。接受IM治疗后，患者的疼痛平均降低了46.9%（95%CI=45.1%至48.6%，P<.001），焦虑平均降低了56.1%（95%CI=54.3%至58.0%，P<.001）。身体疗法和中医疗法在减轻疼痛方面最有效，而在减轻焦虑方面各疗法之间未观察到显著差异。
为肿瘤住院患者提供IM服务可显著减轻疼痛和焦虑。利用电子病历进行的观察性研究提供了有关IM实际应用的独特信息。有必要进行未来研究，应探索阿片类镇痛药与IM疗法在控制疼痛方面的潜在协同作用。
