Scheffler Michael, Koranyi Susan, Meissner Winfried, Strauß Bernhard, Rosendahl Jenny
Jena University Hospital, Institute of Psychosocial Medicine and Psychotherapy, Jena, Germany.
University Hospital Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany.
Burns. 2018 Nov;44(7):1709-1720. doi: 10.1016/j.burns.2017.11.019. Epub 2017 Dec 26.
The aim of the present meta-analysis was to investigate the efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care compared to standard care alone or an attention control. Through a comprehensive literature search in various electronic databases 21 eligible randomized controlled trials (RCTs) were included, comprising a total of 660 patients. Random effects meta-analyses revealed significant positive treatment effects on pain outcomes, Hedges' g=0.58, 95% CI [0.33; 0.84]. Heterogeneity of study effects was substantial, I=72%. Effects were significantly larger for comparisons against treatment as usual (TAU), g=0.69, CI 95% [0.40; 0.98] than for comparisons against attention control groups, g=0.21 [-0.11; 0.54], p<0.001. Distraction interventions, particularly those using virtual reality, and hypnosis revealed the largest effects on pain relief. Non-pharmacological interventions further resulted in a significant small, homogeneous effect on anxiety reduction, g=0.36 [0.20; 0.52]. In summary, benefits of non-pharmacological interventions on procedural pain relief and reduction of mental distress were demonstrated. Results have been proven to be free of publication bias. However, further high quality trials are needed to strengthen the promising evidence.
本荟萃分析的目的是研究与单纯标准护理或注意力对照组相比，非药物干预措施对接受烧伤创面护理的成人程序性疼痛缓解的疗效。通过在各种电子数据库中进行全面的文献检索，纳入了21项符合条件的随机对照试验（RCT），共660例患者。随机效应荟萃分析显示，对疼痛结局有显著的积极治疗效果，Hedges' g = 0.58，95% CI [0.33; 0.84]。研究效应的异质性很大，I = 72%。与常规治疗（TAU）相比的效应显著更大，g = 0.69，95% CI [0.40; 0.98]，而与注意力对照组相比的效应为g = 0.21 [-0.11; 0.54]，p < 0.001。分散注意力干预措施，尤其是那些使用虚拟现实的措施，以及催眠对疼痛缓解的效果最大。非药物干预措施还对焦虑减轻产生了显著的小而同质的效应，g = 0.36 [0.20; 0.52]。总之，证明了非药物干预措施对程序性疼痛缓解和减轻精神痛苦的益处。结果已被证明不存在发表偏倚。然而，需要进一步的高质量试验来加强这一有前景的证据。
