Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.
J Pain. 2018 Oct;19(10):1103.e1-1103.e9. doi: 10.1016/j.jpain.2018.03.013. Epub 2018 Apr 11.
The potential benefits of combining pain education (PE) with clinical hypnosis (CH) has not yet been investigated in individuals with chronic pain. A total of 100 patients with chronic nonspecific low back pain were randomized to receive either: 1) PE alone, or 2) PE with CH. Outcomes were collected by a blinded assessor at 2 weeks and 3 months after randomization. The primary outcomes were average pain intensity, worst pain intensity (both assessed with 11-point numeric rating scales), and disability (24-item Roland Morris Disability Questionnaire) at 2 weeks. At 2 weeks, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.35 points, 95% confidence interval [CI] = .32-2.37) and disability (mean difference = 2.34 points, 95% CI = .06-4.61), but not average pain intensity (mean difference = .67 point, 95% CI = -.27 to 1.62), relative to participants who received PE alone. PE with CH participants also reported more global perceived benefits at 2 weeks (mean difference = -1.98 points, 95% CI = -3.21 to -.75). At 3 months, participants who received PE with CH reported lower worst pain intensity (mean difference = 1.32 points, 95% CI = .29-2.34) and catastrophizing (mean difference = 5.30 points, 95% CI = 1.20-9.41). No adverse effects in either treatment condition were reported. To our knowledge, this is the first trial showing that additional use of hypnosis with PE results in improved outcomes over PE alone in patients with chronic nonspecific low back pain.
This study provides evidence supporting the efficacy of another treatment option for teaching patients to self-manage chronic low back pain that has a relatively low cost and that can be offered in groups.
将疼痛教育（PE）与临床催眠（CH）相结合在慢性疼痛患者中的潜在益处尚未得到研究。共招募了 100 名慢性非特异性腰痛患者，随机分为两组：1）单独接受 PE，或 2）PE 加 CH。盲法评估员在随机分组后 2 周和 3 个月收集结局。主要结局为 2 周时平均疼痛强度、最剧烈疼痛强度（均采用 11 点数字评分量表评估）和残疾（24 项 Roland Morris 残疾问卷）。在 2 周时，接受 PE 加 CH 的患者报告最剧烈疼痛强度较低（平均差异=1.35 分，95%置信区间[CI]为.32-2.37）和残疾程度较低（平均差异=2.34 分，95%CI 为.06-4.61），但平均疼痛强度差异无统计学意义（平均差异=0.67 分，95%CI 为-.27 至 1.62），与单独接受 PE 的患者相比。PE 加 CH 组患者在 2 周时还报告了更多的整体感知益处（平均差异=-1.98 分，95%CI 为-3.21 至-.75）。在 3 个月时，接受 PE 加 CH 的患者报告最剧烈疼痛强度较低（平均差异=1.32 分，95%CI 为.29-2.34）和灾难化程度较低（平均差异=5.30 分，95%CI 为 1.20-9.41）。两种治疗条件均未报告不良反应。据我们所知，这是第一项表明在慢性非特异性腰痛患者中，与单独接受 PE 相比，额外使用催眠与 PE 结合可获得更好结局的试验。
这项研究为另一种治疗选择提供了证据支持，即教患者自我管理慢性腰痛，这种方法成本相对较低，可以在小组中进行。
