Warth Marco, Kessler Jens, Hillecke Thomas K, Bardenheuer Hubert J
Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany.
Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
J Pain Symptom Manage. 2016 Aug;52(2):196-204. doi: 10.1016/j.jpainsymman.2016.01.008. Epub 2016 Apr 15.
Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms.
The present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise.
Eighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants' gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors.
Both VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals' trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow.
Higher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients' physiological response and need to be taken into account in clinical practice and future theory building.
放松干预措施在姑息治疗环境中经常被用于促进症状缓解，但对其潜在机制知之甚少。
本分析旨在研究绝症患者对现场音乐疗法与预先录制的正念练习的心血管反应的心理生理途径。
一家姑息治疗病房的84名患者被随机分配到两种干预措施中的一种。采用多水平模型分析生理变化轨迹。迷走神经介导的心率变异性（VM-HRV）和血容量脉搏振幅（BVP-A）作为自主神经系统反应的指标。将参与者的性别、年龄、基线分数、自评疼痛和治疗分配作为预测变量纳入模型。
VM-HRV和BVP-A均随时间呈现出显著的线性和二次趋势，个体轨迹之间也存在显著的异质性。基线分数、疼痛和治疗显著解释了VM-HRV截距的随机变异。女性的BVP-A水平显著高于男性。此外，治疗分配显著解释了外周血流线性斜率的差异。
音乐治疗组中较高水平的VM-HRV凸显了治疗关系对于临终关怀环境中放松干预效果的重要性。音乐疗法能更显著地降低血管交感神经张力，因此可能适用于姑息治疗中疼痛和压力相关症状的治疗。疼痛的初始自评调节了患者的生理反应，在临床实践和未来理论构建中需要予以考虑。
