Nicholls Judith L, Azam Muhammad A, Burns Lindsay C, Englesakis Marina, Sutherland Ainsley M, Weinrib Aliza Z, Katz Joel, Clarke Hance
Pain Research Unit, Department of Anesthesia and Pain Medicine, Toronto General Hospital.
Department of Psychology, York University.
Patient Relat Outcome Meas. 2018 Jan 19;9:49-64. doi: 10.2147/PROM.S121251. eCollection 2018.
Inadequately managed pain is a risk factor for chronic postsurgical pain (CPSP), a growing public health challenge. Multidisciplinary pain-management programs with psychological approaches, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based psychotherapy, have shown efficacy as treatments for chronic pain, and show promise as timely interventions in the pre/perioperative periods for the management of PSP. We reviewed the literature to identify randomized controlled trials evaluating the efficacy of these psychotherapy approaches on pain-related surgical outcomes.
We searched Medline, Medline-In-Process, Embase and Embase Classic, and PsycInfo to identify studies meeting our search criteria. After title and abstract review, selected articles were rated for risk of bias.
Six papers based on five trials (four back surgery, one cardiac surgery) met our inclusion criteria. Four papers employed CBT and two CBT-physiotherapy variant; no ACT or mindfulness-based studies were identified. Considerable heterogeneity was observed in the timing and delivery of psychological interventions and length of follow-up (1 week to 2-3 years). Whereas pain-intensity reporting varied widely, pain disability was reported using consistent methods across papers. The majority of papers (four of six) reported reduced pain intensity, and all relevant papers (five of five) found improvements in pain disability. General limitations included lack of large-scale data and difficulties with blinding.
This systematic review provides preliminary evidence that CBT-based psychological interventions reduce PSP intensity and disability. Future research should further clarify the efficacy and optimal delivery of CBT and newer psychological approaches to PSP.
疼痛管理不善是慢性术后疼痛（CPSP）的一个风险因素，这是一个日益严峻的公共卫生挑战。包含心理治疗方法的多学科疼痛管理项目，包括认知行为疗法（CBT）、接受与承诺疗法（ACT）以及基于正念的心理治疗，已显示出对慢性疼痛的治疗效果，并且有望在术前/围手术期进行及时干预以管理术后疼痛。我们回顾了相关文献，以确定评估这些心理治疗方法对与疼痛相关的手术结局疗效的随机对照试验。
我们检索了Medline、Medline - In - Process、Embase和Embase Classic以及PsycInfo，以确定符合我们检索标准的研究。在对标题和摘要进行审查后，对所选文章进行偏倚风险评估。
基于五项试验（四项脊柱手术、一项心脏手术）的六篇论文符合我们的纳入标准。四篇论文采用了CBT，两篇采用了CBT - 物理治疗变体；未发现ACT或基于正念的研究。在心理干预的时间和实施方式以及随访时间（1周到2 - 3年）方面观察到相当大的异质性。虽然疼痛强度报告差异很大，但各论文使用一致的方法报告疼痛残疾情况。大多数论文（六篇中的四篇）报告疼痛强度降低，所有相关论文（五篇中的五篇）均发现疼痛残疾有所改善。一般局限性包括缺乏大规模数据以及难以实施盲法。
本系统评价提供了初步证据，表明基于CBT的心理干预可降低术后疼痛强度和残疾程度。未来的研究应进一步阐明CBT及更新的心理方法对术后疼痛的疗效和最佳实施方式。
