Burke Anne L J, Denson Linley A, Mathias Jane L
*Pain Management Unit, Royal Adelaide Hospital, South Australia
School of Psychology, Faculty of Health Sciences, University of Adelaide, South Australia, Australia.
Pain Med. 2016 Dec;17(12):2203-2217. doi: 10.1093/pm/pnw125. Epub 2016 Jun 8.
To examine: 1) whether a single brief pre-clinic educational session improved the well-being and quality of life of individuals entering the wait-list for a tertiary chronic pain (CP) service; and 2) the impact of waiting for services on these outcomes.
Participants were 346 adults, with basic English skills and non-urgent triage codes, who were recruited on referral to a tertiary Australian metropolitan CP unit. Participants were randomized across two conditions: "treatment as usual" (normal wait-list) and "experimental" (normal wait-list plus a 3-hour CP educational session). The educational session encouraged self-management and life engagement despite pain. Multiple outcomes (pain acceptance, pain-related interference, psychological distress, health care utilization [frequency, types], quality of life, health knowledge/beliefs), as well as pain severity and symptom exaggeration, were assessed at intake and again at 2 weeks and 6 months post-educational session (or equivalent for the wait-list group).
Satisfaction with the educational session was moderate-to-high, but attendance was not associated with improved outcomes. At 2 weeks, all study participants reported significant improvements in pain acceptance (willingness, overall acceptance), health care utilization (frequency) and quality of life (physical), which were maintained/enhanced at 6 months. Use of psychological and physical therapies increased significantly by 6 months. There was no functional deterioration while wait-listed.
Attending a brief pre-clinic education session did not improve function. There was no deterioration in wait-listed participants who agreed to be involved in research and who completed study measures at 2 and 6 months, but referral was associated with short-term functional improvements. This is the first study to link positive change with referral to, rather than treatment by, a tertiary CP service.
探讨：1）单次简短的门诊前教育课程是否能改善进入三级慢性疼痛（CP）服务等候名单的个体的幸福感和生活质量；2）等待服务对这些结果的影响。
研究对象为346名具备基本英语技能且非紧急分诊代码的成年人，他们经转诊至澳大利亚大都市的一家三级CP科室。参与者被随机分配到两种情况：“常规治疗”（正常等候名单）和“实验性”（正常等候名单加3小时的CP教育课程）。该教育课程鼓励患者在疼痛的情况下进行自我管理和参与生活。在入组时以及教育课程结束后2周和6个月（或等候名单组的等效时间）对多种结果（疼痛接受度、疼痛相关干扰、心理困扰、医疗保健利用情况[频率、类型]、生活质量、健康知识/信念）以及疼痛严重程度和症状夸大情况进行评估。
对教育课程的满意度为中到高，但出席情况与改善结果无关。在2周时，所有研究参与者报告在疼痛接受度（意愿、总体接受度）、医疗保健利用情况（频率）和生活质量（身体方面）方面有显著改善，这些改善在6个月时得以维持/增强。到6个月时，心理和物理治疗的使用显著增加。在等候名单上时功能没有恶化。
参加简短的门诊前教育课程并未改善功能。同意参与研究并在2个月和6个月完成研究测量的等候名单上的参与者功能没有恶化，但转诊与短期功能改善相关。这是第一项将积极变化与转诊至三级CP服务而非接受其治疗联系起来的研究。
